Oblique-ilioischial plate technique: a novel method for acetabular fractures involving low posterior column

Abstract

Background Complex acetabular fractures involving the anterior and posterior columns are an intractable clinical challenge. The study investigated the safety and efficacy of oblique-ilioischial plate technique for acetabular fractures involving low posterior column. Methods A retrospective analysis of 18 patients operated with the oblique-ilioischial plate technique by the modified Stoppa approach (or combined with iliac fossa approach) between August 2016 and July 2021 for low posterior column acetabular fractures was conducted. The anterior column was fixed with a reconstructed plate from the iliac wing along the iliopectineal line to the pubis. The low posterior column was fixed with the novel oblique-ilioischial plate running from the ilium to the ischial ramus. Operative time, intraoperative blood loss, reduction quality, and postoperative hip function were recorded. Results Out of the 18 patients, 10 were male and 8 were female. The mean age was 48.6±10.2 years (range: 45–62 years); The mean interval from injury to operation was 7.2±1.4 days (range: 5–19 days); The mean operative time was 2.1±0.3 h (range: 1.0–3.2 hours); The mean intraoperative blood loss was 300±58.4 mL (range: 200–500 mL). Postoperative reduction (Matta’s criteria) was deemed as excellent (n = 9), good (n = 4), and fair (n = 5). At the final follow-up, the hip function (modified Merle d’Aubigne-Postel scale) was deemed as excellent (n = 11), good (n = 3), and fair (n = 4). The mean union time was 4.5±1.8 months (range: 3–6 months). No implant failure, infection, heterotopic ossification, or neurovascular injury were reported. Conclusion The oblique-ilioischial plate technique via anterior approach for acetabular fractures involving low posterior column offers reliable fixation, limited invasion, little intraoperative bleeding, and fewer complications. However, larger multicenter control studies are warranted.

Medial surface plating of posterior column through the anterior intrapelvic approach in acetabulum fractures with involvement of both columns

“…Recently, Chen et al 18 also mentioned plating of the posterior column through the AIP approach, but they applied the plate from ilium to the ischial spine, thereby making it difficult to include any additional infrapectineal plate, which is often required in addition to the posterior column plating to buttress the quadrilateral plate effectively. We applied our posterior column plate starting below the pectineal line, as this allows us to place an additional infrapectineal plate.…”