Omega plate for the treatment of acetabular fractures involving the quadrilateral plate

Abstract

This retrospective study aimed to assess the outcome of a modified Stoppa approach using an anatomically precontoured plate for the treatment of acetabular fractures. In total, 30 patients (mean age 50.3 years; 25 men and 5 women) with acetabular fractures were treated between January 1, 2018 and December 31, 2019. In all 30 cases, fracture reduction was performed through a modified Stoppa approach and fixed with the omega plate. In specific fracture patterns, additional approaches were needed (lateral window in 4 cases and posterior Kocher-Langenbeck approach in 7 cases). Patients were assessed for restoration of the hip joint congruency, complications, and overall fracture reduction. Quality of reduction was categorized based on Matta's radiological principles and to assess functional outcome the Merle d' Aubigné-Postel and Harris hip score was used. The average anesthesia time was 253.6 min, the mean intraoperative blood lost was 266.6 ml and the mean intraoperative fluoroscopy dose was 3.21 mGy. According to Matta criteria for reduction quality, anatomical reduction was recorded in 22 cases, imperfect reduction in 6 cases and 2 cases had poor reduction. The average follow-up was 22.5 months. Malunion, loss of reduction or implant loosening were not recorded. Late complications included one case of avascular necrosis of the femoral head and post-traumatic arthritis changes in 5 cases. At the final follow-up, a mean Merle d'Aubigné-Postel score of 13.26±4.46 and a mean Harris score of 86.03±13.37 were recorded. The possibility of an anatomically precontoured plate with subsequent lower operative time combined with stable fixation of the primary acetabular fracture fragments and the quadrilateral plate makes the omega plate a viable option for treating acetabular fractures with a very low complication rate and good to excellent results in 89% of the cases.

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

“…However, those studies did not specifically focus on the problem of low posterior column fracture fixation. In our series, the operation time, intraoperative blood loss, postoperative scores, and union time showed no significant differences with previous literature [ 20 , 23 , 24 ]. This suggests that the oblique-ilioischial plate technique is a practical and effective option for acetabular low posterior column fracture, especially in the case of acetabular fractures involving both anterior and posterior columns.…”

“…The methods of reduction and fixation of acetabular fracture are various. Veliceasa et al performed a study of a modified Stoppa approach using an anatomically precontoured plate for the treatment of acetabular fractures, which achieved a very low complication rate and good to excellent results in 89% of the cases [ 20 ]. Mitchell et al suggest that it is an effective and feasible method to address transverse acetabular fractures with regularly performed a posterior approach and used a clamp from the back to the front to reduce and hold in position the anterior column before the final fixation with screws [ 21 ].…”

Third-Generation Dynamic Anterior Plate-Screw System for Quadrilateral Fractures: Digital Design Based on 834 Pelvic Measurements

“…With the development of modern surgical techniques and the in-depth understanding of pelvic and acetabular anatomy, open reduction and internal fixation have become the optimal choice for most quadrilateral plate fractures with significant displacement. The treatment options have evolved from simple pins and screws [ 7 ] to cerclage wiring [ 8 ] and plates [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. However, it has to be mentioned that there is a high risk of screws penetrating into the hip joint cavity due to the features of thin and weak bone in the quadrilateral region.…”

“…However, it has to be mentioned that there is a high risk of screws penetrating into the hip joint cavity due to the features of thin and weak bone in the quadrilateral region. To circumvent this problem, many scholars have invented various indirect fixation methods for quadrilateral fracture blocks such as the spring plate [ 9 , 10 ], the quadrilateral surface buttress plate [ 11 , 12 , 13 ], and the infrapectineal plate [ 14 , 15 ]. Although multiple fixation strategies have been proposed, debates about the best internal fixation methods for this type of fracture continue [ 16 ].…”