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Zhang Q, Jin L, Hao X, Zheng W, Zhou F, Zhang S, Li T, Xiong X, He Y, Chen X, Huang J. H-Shaped Anatomical Titanium Plate: Biomechanical Validation and Clinical Application in the Treatment of Complex Posterior Wall/Column Acetabular Fractures. Orthop Surg 2025. [PMID: 40329742 DOI: 10.1111/os.70053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 04/09/2025] [Accepted: 04/11/2025] [Indexed: 05/08/2025] Open
Abstract
OBJECTIVE Approximately 80% of acetabular fractures involve the posterior wall and posterior column, which are complex and challenging to treat. The H-shaped anatomical titanium plate (HTP) facilitates anatomical reduction, minimizes complications, and enhances safety, efficacy, and speed. This study aims to conduct biomechanical testing and clinical evaluation of HTP to assess its stability and efficacy in treating these fractures. METHODS In the biomechanical research, posterior column with posterior wall fractures was created on nine acetabular models procured from Sawbones, USA and were allocated to three fixation groups: (1) a single reconstruction plate combined with a single cortical screw (PCS), (2) double parallel reconstruction plates (2P), (3) HTP. Following anatomic reduction, cyclic loading and destructive experiments were conducted to assess the efficacy of different fixation devices under various loads for the posterior wall and column, as well as their peak load and structural stiffness. Additionally, we retrospectively analyzed the clinical data of 53 patients (46 males, 7 females; mean follow-up 24.6 ± 3.2 months) with the HTP at our hospital from April 2017 to January 2023. Clinical outcomes mainly included changes in postoperative pain, reduction quality (Matta criteria), hip function (Merle d'Aubigné Postel/Harris scores), and the incidence of complications. RESULTS Biomechanical results showed that in cyclic loading tests, the relative displacement of the posterior wall and the posterior column fixed with the HTP was smallest, with statistically significant differences (p < 0.05). In the destructive experiment, compared to the 2P group (2062.89 ± 375.45 N, 412.16 ± 25.87 N/mm) and the PCS group (1477.89 ± 161.57 N, 204.21 ± 34.94 N/mm), the HTP group (3342.67 ± 354.15 N, 652.52 ± 24.25 N/mm) demonstrated superior peak load and structural stiffness, with statistically significant differences (p < 0.05). Clinically, Postoperative Visual Analogue Scale scores significantly decreased, indicating effective pain management. 84.91% achieved anatomic reduction, with 92.45% and 90.56% good/excellent functional outcomes (Merle d'Aubigné Postel and Harris scores, respectively). The incidence of various complications was low, with no cases of implant failure observed. CONCLUSIONS The HTP demonstrates robust stability in biomechanical experiments, offering distinct advantages for clinical applications and widespread adoption. In the treatment of the posterior column/posterior wall fractures, the integrated fixation of HTP aligns with the physiological anatomy of the acetabulum and has the advantages of simple operation, short operation time, strong stability, minimal risk of vascular and nerve injury, and fewer complications.
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Affiliation(s)
- Qiaoli Zhang
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Liang Jin
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Xiaorui Hao
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
| | - Weijie Zheng
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Fei Zhou
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
| | - Shuxin Zhang
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
| | - Tianfeng Li
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Xiaohui Xiong
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Yihan He
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Xiaojie Chen
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jiexin Huang
- Department of Orthopedic Surgery, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
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Scherer J, Youssef Y, Wendler T, Fischer B, Schleifenbaum S, Osterhoff G. Comparison of elastic stable intramedullary nailing versus retrograde screw fixation for pubic ramus fractures-a biomechanical study. Eur J Trauma Emerg Surg 2025; 51:129. [PMID: 40057598 PMCID: PMC11890244 DOI: 10.1007/s00068-025-02791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 02/02/2025] [Indexed: 05/13/2025]
Abstract
BACKGROUND Percutaneous minimally invasive retrograde screw fixation is a widely accepted treatment strategy for patients with superior ramus fractures and has shown good biomechanical stability compared to plating. Recently, elastic stable intramedullary nailing (ESIN) devices have been proposed as an alternative in the treatment of superior ramus fractures. However, biomechanical studies on this new treatment are lacking. Thus, the aim of this study was to compare the biomechanical stability of ESIN in pubic ramus fractures versus retrograde screw fixation. METHODS Standardized pubic ramus fractures (Nakatani type II) were created in fresh-frozen paired hemipelves. Fractures were either stabilized with a 6.5 mm cannulated screw (n = 4) or a 3.5 mm Stainless Steel Elastic Nail System (n = 4). In a validated setup, a cyclic loading protocol was applied with increasing axial force (1500 cycles, 250-750 N). Outcome parameters were fracture mobility over time, fracture displacement and construct survival. Descriptive and opto-metric methods were used to describe the mode of failure. RESULTS Amongst all tested hemipelves (n = 8), no construct failure was observed. There was no significant difference in mean vertical fracture displacement between the groups (ESIN 0.07 mm, SD 0.12 versus screw 0.04 mm, SD 0.05; p = 0.773). After 500 cycles at 250 N, mean vertical fracture displacement was 0.09 mm (SD 0.16) in the ESIN group and 0.03 mm (SD 0.04) in the screw group (p = 0.773). After subsequent 500 cycles at 500 N in the vertical plane, mean fracture displacement increased to 0.35 mm (SD 0.31) in the ESIN group and to 0.14 mm (SD 0.17) in the screw group (p = 0.281). With a maximum load of 750 N, after 500 cycles, mean fracture displacement was 0.58 mm (SD 0.51) in the ESIN group and 0.31 mm (SD 0.26) in the screw group (p = 0.376). There was no difference between the implants regarding the accumulated fracture movement over time (ESIN 494 mm*cycles, SD 385 versus screw 220 mm*cycles, SD 210; p = 0.259). CONCLUSIONS In this in-vitro biomechanical study, fixation of superior ramus fracture using ESIN was not different in construct survival, relative motion to fracture, and fracture displacement when compared to retrograde screw fixation.
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Affiliation(s)
- Julian Scherer
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
- Department of Traumatology, University Hospital of Zurich, Zurich, Switzerland.
| | - Yasmin Youssef
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Toni Wendler
- Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Benjamin Fischer
- Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Stefan Schleifenbaum
- Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Freude T, Gänsslen A, Krappinger D, Lindahl J. Quadrilateral plate fractures. Arch Orthop Trauma Surg 2024; 145:51. [PMID: 39680200 DOI: 10.1007/s00402-024-05698-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 09/28/2024] [Indexed: 12/17/2024]
Abstract
During the last two decades, extended scientific interest focused on quadrilateral plate (QLP) fractures as part of common acetabular fractures. The QLP corresponds to the medial wall of the acetabulum, and different fracture pattern of Letournel´s fracture types are associated with concomitant QLP fractures. Except anterior and posterior wall fractures, all other fracture types may be associated with QLP fractures. QLP fracture features include simple fracture lines up to highly comminuted fractures. A detailed preoperative analysis of these fractures is important to get a better understanding of intraoperative decision making. No consensus exists regarding the optimal classification and treatment of QLP fractures. Various operative approaches and treatment concepts exists depending on the specific QLP fracture type and the acetabular fracture type. Several new implants were development for optimal but often individual stabilization concepts. The gold-standard is still some medial buttressing during internal fixation predominantly using plates, but also screw fixation is considered an option. Additional dome impactions must be considered as an integral part in any QLP fracture analysis and stabilization.
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Affiliation(s)
- T Freude
- University Hospital for Orthopaedics and Traumatology, Müllner Hauptstraße 48, Salzburg, A-5020, Austria
| | - Axel Gänsslen
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany.
- Department of Trauma and Orthopedics, Johannes Wesling Hospital, Minden, Germany.
| | - D Krappinger
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, Innsbruck, A-6020, Austria
| | - J Lindahl
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Lan S, Meng C, Yuan G, Wang G, Liu X, Cai X. Fractures of the quadrilateral plate treated with a reconstruction plate and trans-plate quadrilateral screws: An experimental study on cadaveric specimens and finite element analysis. Medicine (Baltimore) 2024; 103:e40850. [PMID: 39686433 PMCID: PMC11651477 DOI: 10.1097/md.0000000000040850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
Quadrilateral plate fracture is one of the most complex and challenging pelvic lesions. Operative reduction and internal fixation are the gold standard management for displaced quadrilateral plate fractures. Traditional methods include various kinds of operative reduction and internal fixation through either anterior or posterior approaches using various combinations of plates and lag screws or acute total hip arthroplasty. Here we introduced a new fixation technique named reconstruction plate combined with trans-plate quadrilateral screws. We performed a cadaveric study to determine the biomechanical properties of this system comparing with conventional titanium plate combined with 1/3 tube titanium plate in a both-column acetabular fracture model in standing position. Besides, a finite element model of both-column acetabular fractures fixed by this system was developed and the mechanical properties of implants and acetabular fractures were analyzed. The biomechanical test showed the superiority of reconstruction plate combined with trans-plate quadrilateral screws over conventional titanium plate combined with 1/3 tube titanium plate in treating both-column quadrilateral plate fractures in standing position. Later finite element analysis confirmed the stabilities of the fractures under 1-legged stance. Thus, reconstruction plate combined with trans-plate quadrilateral screws provides an alternative method in treating quadrilateral plate fractures.
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Affiliation(s)
- Shenghui Lan
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
| | - Chengfei Meng
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
| | - Gongwu Yuan
- Department of Orthopaedics, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Guodong Wang
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
| | - Ximing Liu
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
| | - Xianhua Cai
- Department of Orthopaedics, Wuhan General Hospital, Wuhan, Hubei Province, China
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Lodde MF, Katthagen C, Klimek M, Abshagen K, Peez C, Große-Allermann A, Raschke MJ, Riesenbeck O. Angular stable plate fixation provides favorable biomechanical stability in simulated T-shaped acetabular fractures: a biomechanical study. Acta Orthop 2024; 95:701-706. [PMID: 39607368 PMCID: PMC11603667 DOI: 10.2340/17453674.2024.42490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 11/08/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND AND PURPOSE The treatment of acetabular fractures remains technically demanding. In the case of reduced bone quality or fracture morphology reducing the amount of bone available for fixation, locking plates should provide considerable advantages. The aim of the present study was to compare conventional and locking plate fixation. It was hypothesized that locking plate fixation provides less displacement and higher construct stiffness. METHODS A T-shaped acetabular fracture was simulated in 16 synthetic pelvic models. The fracture was addressed with a biplanar 10-hole 2-column plate buttressing the medial acetabular wall. Optical markers were attached to the fracture sites for motion tracking. Standardization of the acetabulum loading mechanism was performed using a unipolar hemiarthroplasty. The primary outcome measure was displacement at the fracture sites. The secondary outcome measure was the construct stiffness (N/mm). RESULTS Fracture displacement was less in the group of angular stable implants compared with the group fixed with conventional non-locking implants. Under cyclic loading displacement was less in the group of locking plate fixation. No differences in mean initial axial stiffness were detected between locking plate fixation (407 N/mm) and conventional plating (308 N/mm, ∆ 99 N/mm, 95% confidence interval -48 to 245). CONCLUSION We showed that locking plate fixation buttressing the medial acetabular wall achieved less fracture displacement but showed no differences in axial stiffness compared with conventional plating.
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Affiliation(s)
- Moritz F Lodde
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
| | - Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Karl Abshagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Arian Große-Allermann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Oliver Riesenbeck
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Andrés-Peiró JV, Lloret-Peiró C, Bustos-Mardones A, Martínez-Collado P, Tomás-Hernández J, Selga-Marsá J, Piedra-Calle CA, García-Sánchez Y, Teixidor-Serra J. Intrapelvic suprapectineal acetabular plates interfere with the quality of reduction evaluations on postoperative X-rays. A retrospective case series. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00161-9. [PMID: 39393486 DOI: 10.1016/j.recot.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 09/22/2024] [Accepted: 10/04/2024] [Indexed: 10/13/2024] Open
Abstract
INTRODUCTION Intrapelvic suprapectineal plates play an important role in acetabular fracture fixation. However, the shape of these implants may interfere with the quality of reduction evaluations using plain X-rays. We sought to evaluate this artifact and its relationship with CT findings. MATERIALS AND METHODS In a retrospective, single-center series of 22 acetabular fractures, postoperative AP, alar and obturator X-ray views and CT images were evaluated by three independent observers. Cohen's kappa was used to examine interrater reliability. RESULTS Suprapectineal plates interfered with the evaluation of the weight-bearing surface in 75.3%, and with all three oblique views in 43.9% of cases. The central segment was most consistently interfered with, corresponding to the area where the greatest malreduction was in 46.9% coronal and 42.4% of sagittal CT views. CONCLUSIONS Since the quality of reduction has prognostic value and is a necessary guide for the surgical team, that CT may be considered for the postoperative examination of the most challenging acetabular fracture cases.
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Affiliation(s)
- J V Andrés-Peiró
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de investigación en Cirugía Reconstructiva del Aparato Locomotor, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España.
| | - C Lloret-Peiró
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - A Bustos-Mardones
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - P Martínez-Collado
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Tomás-Hernández
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de investigación en Cirugía Reconstructiva del Aparato Locomotor, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - J Selga-Marsá
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de investigación en Cirugía Reconstructiva del Aparato Locomotor, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - C A Piedra-Calle
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de investigación en Cirugía Reconstructiva del Aparato Locomotor, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - Y García-Sánchez
- Grupo de investigación en Cirugía Reconstructiva del Aparato Locomotor, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - J Teixidor-Serra
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de investigación en Cirugía Reconstructiva del Aparato Locomotor, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
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Tekin SB, Karsli B, Ogumsogutlu E, Bozgeyik B, Karabulut C. Comparison of Surgical Results of Modified Stoppa and Ilioinguinal Approach in Patients with Acetabular Fractures Involving Quadrilateral Surface Fractures. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:10-16. [PMID: 38808040 PMCID: PMC11128694 DOI: 10.14744/semb.2023.64280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 05/30/2024]
Abstract
Objectives The aim of this study was to evaluate the results of surgical treatment in patients with acetabular fractures with a fractured quadrilateral surface treated using two different approaches. Methods The study included 106 patients who were operated on with ilioinguinal (group A) or modified Stoppa (group B) technique for acetabular fracture with a fractured quadrilateral surface between 2011 and 2020 in our clinic. The quality of reduction was evaluated according to Matta criteria and postoperative pelvic (anteroposterior, external oblique, iliac oblique) radiographs. Evaluation of hip function was recorded using the Merle d'aubigne and Postel Score and Harris Hip Score. Results Among the patients included in the study, there were 45 patients in group A and 61 patients in group B. When the group data were compared, it was seen that the modified Stoppa approach was superior in terms of intraoperative reduction quality, radiological data, Harris hip score, Merle d'aubigne and PostelScore. (Respectively p=0.40, p=0.49, p=0.040, p=0.028). Conclusion : Modified Stoppa approach has successful clinical and radiological outcomes and better reduction quality and hip scores than ilioinguinal approaches in acetabular fractures involving quadrilateral plates.
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Affiliation(s)
- Sezgin Bahadir Tekin
- Department of Orthopedic Surgery, Gaziantep University Hospital, Gaziantep, Türkiye
| | - Burcin Karsli
- Department of Orthopedic Surgery, Gaziantep University Hospital, Gaziantep, Türkiye
| | - Erman Ogumsogutlu
- Department of Orthopedic Surgery, Akmagdeni State Hospital, Yozgat, Türkiye
| | - Bahri Bozgeyik
- Department of Orthopedic Surgery, Kadirli State Hospital, Osmaniye, Türkiye
| | - Cagri Karabulut
- Department of Orthopedic Surgery, Gaziantep University Hospital, Gaziantep, Türkiye
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Tosyalı HK, Elibol FKE, Hancıoğlu S, Kaçmaz SE, Çalışkan Öİ, Tolunay T, Demir T, Okçu G. Which implant is better for the fixation of posterior wall acetabular fractures: A conventional reconstruction plate or a brand-new calcaneal plate? Injury 2024; 55:111413. [PMID: 38394707 DOI: 10.1016/j.injury.2024.111413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Increased posterior wall acetabular fractures among older adults, require precise treatment to restore stability to the joint, lower the risk of degenerative arthritis, and enhance overall functional recovery. The purpose of this study was to compare the fixation stability and mechanical characteristics of calcaneal buttress plate and conventional reconstruction plate under different loading condition. METHODS Typical acetabular posterior wall fractures were created on twenty synthetic hemipelvis models. They were fixed with calcaneus plate and reconstruction plate. Dynamic and static tests were performed. Displacements of fracture line and stiffness were calculated. FINDINGS After dynamic loading, calcaneus plate fixation has significantly less displacement than the reconstruction plate on the superior posterior wall. Under static loading condition, the calcaneus plate group has significantly less displacement than the reconstruction plate group on the inferior posterior part of the fracture. The average stiffness values of the calcaneus plate group and the reconstruction plate group were 265.16±53.98 N/mm and 167.48±36.87 N/mm, respectively and a statistically significant difference was found between the two groups. INTERPRETATION The calcaneal plate group demonstrated better stability along the fracture line after dynamic and static loading conditions. Especially when the fragment was on the acetabulum's superior posterior, inferior posterior, and inferior rim, Calcaneal buttress plates offer biomechanically effective choices.
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Affiliation(s)
- Hakan Koray Tosyalı
- Department of Orthopedics and Traumatology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatma Kübra Erbay Elibol
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara, Turkey.
| | - Sertan Hancıoğlu
- Department of Orthopedics and Traumatology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Suat Emre Kaçmaz
- Department of Orthopedics and Traumatology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Özde İrem Çalışkan
- Department of Biomedical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Tolga Tolunay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Teyfik Demir
- Department of Mechanical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Güvenir Okçu
- Department of Orthopedics and Traumatology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
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Hazra S, Saha N, Mallick SK, Saraf A, Kumar S, Ghosh S, Chandra M. Medial surface plating of posterior column through the anterior intrapelvic approach in acetabulum fractures with involvement of both columns. Bone Jt Open 2024; 5:147-153. [PMID: 38368906 PMCID: PMC10875389 DOI: 10.1302/2633-1462.52.bjo-2023-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Aims Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. Methods We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d'Aubigné score and Matta's radiological grading at one year and at latest follow-up. Results Immediate postoperative radiological Matta's reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d'Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta's radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d'Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta's radiological grading at latest follow-up also remained unchanged. Conclusion Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window.
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Ardiansyah A, Dilogo IH, Gunawan B, Oesman I, Herlambang D. Functional, radiological, and quality of life outcome of unstable acetabular fracture with quadrilateral plate involvement at a tertiary care center in Jakarta, Indonesia. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1131-1140. [PMID: 37966556 DOI: 10.1007/s00590-023-03752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/25/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Unstable acetabular fracture remains a complex fracture that requires technically demanding surgery for orthopedic surgeons. Quadrilateral plate (QP) fractures of the acetabulum are a challenging group of acetabular fractures to manage. However, the literature regarding the management of these injuries are limited. The QP is a relatively thin medial wall of the acetabulum and intra-articular; thus, anatomical reduction and stable fixation are required for satisfactory outcome. This study aims to determine the functional, radiological, and quality of life outcome of unstable acetabular fracture with QP involvement. METHODS This was a retrospective cohort study conducted at Cipto Mangunkusumo General Hospital during the period of 2010-2020. Patients with unstable acetabular fractures with and without QP involvement were included in this study. They were followed up postoperatively at 1, 6, and 12 months. Functional outcome was assessed using the Harris Hip Score (HHS), Merle D'Aubigne, and Oxford Hip Score (OHS); while radiology outcome was assessed using Matta Outcome Grading; and quality of life was assessed using the SF-36. RESULTS This study involved 53 subjects with a median age was 29 (18-75) years of age. Twenty-eight (52.8%) subjects had unstable acetabular fracture with QP involvement. Twenty-five (47.2%) subjects had unstable acetabular fracture without QP involvement. Twenty-five (47.2%) subjects were fixed using quadrilateral hook plate, 3 (5.7%) with infrapectineal plate, 10 (18.8%) with posterior column plate, and 15 (28.3%) with suprapectineal plate. The median intraoperative bleeding in those with unstable acetabular fracture with QP involvement was 600 (300-4000) ml, which was higher than those without QP involvement (400 [100-1700] ml). Those with QP involvement achieved anatomical reduction in 20 (71.4%) subjects. Whereas, the subjects without QP involvement achieved anatomical reduction 23 patients (92%). Subjects with QP involvement had significantly lower functional, radiological, and quality of life outcomes compared to those without quadrilateral plate involvement based on Harris Hip Score (p = 0.046), Merle D'Aubigne (0.001), Oxford Hip Score (0.001), Matta Outcome Grading (0.004), and SF-36 (0.001). Patients with quadrilateral hook plate showed no significant functional, and radiological outcome difference compared to patients with infrapectineal plate based on Harris Hip Score (p = 0.582), Merle D'Aubigne (0.698), Oxford Hip Score (1.000), and Matta Outcome Grading (1.000). In addition, we also found no significant functional, radiological, and quality of life outcome difference between posterior column plate and suprapectineal plate group based on Harris Hip Score (p = 0.200), Merle D'Aubigne (0.643), Oxford Hip Score (0.316), Matta Outcome Grading (1.000), and SF-36 (0.600). CONCLUSIONS Patients with unstable acetabular fracture with quadrilateral plate involvement subject had significantly lower functional, radiological, and quality of life outcomes compared to those without quadrilateral plate involvement. Both quadrilateral hook and infrapectineal plates demonstrated non-significant functional and radiological outcomes difference. Posterior column plate also resulted in the same functional, radiological, and quality of life outcome compared with suprapectineal fixation.
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Affiliation(s)
- Ardiansyah Ardiansyah
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bambang Gunawan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ihsan Oesman
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Kim BS, Bae KC, Cho CH, Lee KJ, Lee IG, Lee MG, Min BW. Is the Direct Fixation of Displaced Quadrilateral Plates in Acetabular Fractures Necessary? J Clin Med 2023; 12:6994. [PMID: 38002609 PMCID: PMC10672613 DOI: 10.3390/jcm12226994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Quadrilateral plate fractures represent a heterogeneous group of acetabular fractures. Accurate reduction is required to prevent post-traumatic arthritis. The purpose of this study is to determine the reduction effect of the direct fixation of quadrilateral plates in acetabular fractures, and to evaluate the strength of direct fixation compared to indirect fixation. Between 2005 and 2021, 49 patients underwent surgery for open reduction and internal fixation in acetabular fractures with severely displaced quadrilateral plates. Twenty-nine patients comprised the indirect fixation group, and twenty patients comprised the direct fixation group. In a comparison of primary outcome between two groups, 10 out of 29 indirect-group patients and 1 out of 20 direct-group patients developed post-traumatic osteoarthritis, wherein the difference between the two groups is statistically significant. In the assessment of postoperative Matta's radiological reduction status, 19 out of 20 patients in the direct group had achieved anatomical and congruent reduction. The treatment using a direct reduction and internal fixation improved the reduction quality of articular displacement and offered a better survivorship of the affected hip joint.
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Affiliation(s)
- Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - Ki-Cheor Bae
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - Kyung-Jae Lee
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - In Gyu Lee
- Marine Corps Education & Training Group, Republic of Korea Marine Corps, Pohang 37896, Republic of Korea;
| | - Min-Gyu Lee
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
| | - Byung-Woo Min
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea; (B.-S.K.); (K.-C.B.); (C.-H.C.); (K.-J.L.); (M.-G.L.)
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Liu X, Gao J, Wu X, Deng J, Li Z, Li R, Zhang L, Liu J, Li M. Comparison between Novel Anatomical Locking Guide Plate and Conventional Locking Plate for Acetabular Fractures: A Finite Element Analysis. Life (Basel) 2023; 13:2108. [PMID: 38004248 PMCID: PMC10671966 DOI: 10.3390/life13112108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/15/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment of complex acetabular fractures remains a complicated clinical challenge. Our self-designed novel anatomical locking guide plate (NALGP) has previously shown promising potential in T-shaped acetabular fractures (TAF), but a direct comparison with conventional fixations is yet to be made. The TAF model was established based on a volunteer's computer tomography data and then fixed with double column locking plates (DLP), a posterior column locking plate with anterior column screws (LPACS), and our NALGP. Forces of 200 N, 400 N, and 600 N were then loaded on the model vertically downward, respectively. The stress distribution and peaks and maximum displacements at three sites were assessed. We found that the stress area of all three plates was mainly concentrated around the fracture line, while only the matching screws of the NALGP showed no obvious stress concentration points. In addition, the NALGP and DLP showed significantly less fracture fragment displacement than the LPACS at the three main fracture sites. The NALGP was found to have less displacement than DLP at the posterior column and ischiopubic branch sites, especially under the higher loading forces of 400 N and 600 N. The fixation stability of the NALGP for TAF was similar to that of DLP but better than that of LPACS. Moreover, the NALGP and its matching screws have a more reasonable stress distribution under different loads of force and the same strength as the LPACS.
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Affiliation(s)
- Xiao Liu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Jianpeng Gao
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Xiaoyong Wu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Junhao Deng
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Zijian Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Ran Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Licheng Zhang
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Jianheng Liu
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
| | - Ming Li
- Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, China; (X.L.); (J.G.); (X.W.); (J.D.); (Z.L.); (R.L.); (L.Z.)
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxin Road, Beijing 100853, China
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Berk T, Zderic I, Schwarzenberg P, Pfeifer R, Pastor T, Halvachizadeh S, Richards RG, Gueorguiev B, Pape HC. Anterior column acetabulum fracture fixation with a screw-augmented acetabular cup-a biomechanical feasibility study. Clin Biomech (Bristol, Avon) 2023; 109:106095. [PMID: 37757678 DOI: 10.1016/j.clinbiomech.2023.106095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
BACKROUND The beneficial effects of unrestricted postoperative full weight bearing for elderly patients suffering hip fractures have been demonstrated. However, there is still existing disagreement regarding acetabular fractures.The aim of this biomechanical study was to evaluate the initial load bearing capabilities of different fixation constructs of anterior column fractures (ACFs) in osteoporotic bone. METHODS Artificial pelvises with ACFs were assigned to three groups (n = 8) and fixed with either a 7.3 mm partially threaded antegrade cannulated screw (group AASS), an anteriorly placed 3.5 mm plate (group AAPF), or a press-fit acetabular cup with screw augmentation (group AACF). All specimens underwent ramped loading from 20 N preload to 200 N at a rate of 18 N/s, followed by progressively increasing cyclic testing at 2 Hz until failure performed at a rate of 0.05 N/cycle. Relative displacements of the bone fragments were monitored by motion tracking. FINDINGS Initial stiffness (N/mm) was 118.5 ± 34.3 in group AASS, 100.4 ± 57.5 in group AAPF, and 92.9 ± 44.0 in group AACF, with no significant differences between the groups, p = 0.544. Cycles to failure were significantly higher in groups AACF (8364 ± 2243) and AAPF (7827 ± 2881) compared to group AASS (4440 ± 2063), p ≤ 0.041. INTERPRETATION From a biomechanical perspective, the minimally invasive cup fixation with screw augmentation demonstrated comparable stability to plate osteosynthesis of ACFs in osteoporotic bone. The results of the present study do not allow to conclusively answer whether immediate full weight bearing following cup fixation shall be allowed. Given its similar performance to plate osteosynthesis, this remains rather an utopic wish and a more conservative approach deems more reasonable.
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Affiliation(s)
- Till Berk
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
| | | | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
| | - Tatjana Pastor
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland; Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Switzerland.
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
| | - R Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Harald-Tscherne Laboratory for orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland.
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Chen K, Yao S, Yin Y, Wan Y, Ahn J, Zhu S, Chen H, Fan S, Guo S, Yi C, Li L, Hou Z, Guo X. A new classification for quadrilateral plate fracture of acetabulum. Injury 2023; 54:110762. [PMID: 37164901 DOI: 10.1016/j.injury.2023.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Recently, quadrilateral plate (QLP) fractures of acetabulum have attracted increasing attention. However, evidence for the appropriate classification of QLP fractures is still lacking, making it difficult to understand and manage these fractures. This study aimed to introduce a new classification for QLP fractures and evaluate its reproducibility. METHODS A series of 1101 consecutive patients with acetabular fractures from 8 level-I trauma centers were enrolled in this study. All patients underwent preoperative radiograph and computed tomography imaging. QLP fractures were identified and classified using the new and Judet-Letournel classification system. The inter- and intra-observer reliabilities (kappa coefficients, κ) of these two systems were investigated by 4 observers. Furthermore, surgical approaches and fixation methods for each fracture type are described. RESULTS In total, 243 (243/1101, 22%) patients with QLP fractures were identified and included in this analysis. The mean κ value of the intra-observer reliability was 0.84 (range, 0.763-0.919) for the new classification, indicating excellent agreement, and the inter-observer reliability was 0.762 (range, 0.625-0.876), indicating substantial agreement. The values were 0.649 (range, 0.523-0.708) and 0.584 (0.497-0.646), respectively, according to the Judet-Letournel classification. Six cases (6/243, 2.5%) could not be classified using the Judet-Letournel classification. The selection of surgical approaches and fixation methods depends on the fracture type; however, an anterior intra-pelvic approach and buttressing fixation using the plate or screw are preferred for QLP fractures. CONCLUSION This study presents a new classification for QLP fractures, showing higher intra- and inter-observer reliabilities than those obtained using the Judet-Letournel classification. This allowed us to obtain an in-depth and comprehensive understanding of QLP fractures. Additionally, the new classification might guide further studies on surgical strategies for QLP fractures. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China; Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shiwen Zhu
- Department of Orthopedics&Traumatology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Hua Chen
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, People's Republic of China
| | - Shicai Fan
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People's Republic of China
| | - Shuquan Guo
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chengla Yi
- Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Chen K, Huang G, Wan Y, Yao S, Su Y, Li L, Guo X. Biomechanical study of different fixation constructs for anterior column and posterior hemi-transverse acetabular fractures: a finite element analysis. J Orthop Surg Res 2023; 18:294. [PMID: 37041549 PMCID: PMC10088117 DOI: 10.1186/s13018-023-03715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 03/15/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To compare the biomechanical properties and stability, using a finite element model, of four fixation constructs used for the treatment of anterior column and posterior hemi-transverse (ACPHT) acetabular fractures under two physiological loading conditions (standing and sitting). METHODS A finite element model simulating ACPHT acetabular fractures was created for four different scenarios: a suprapectineal plate combined with posterior column and infra-acetabular screws (SP-PS-IS); an infrapectineal plate combined with posterior column and infra-acetabular screws (IP-PS-IS); a special infrapectineal quadrilateral surface buttress plate (IQP); and a suprapectineal plate combined with a posterior column plate (SP-PP). Three-dimensional finite element stress analysis was performed on these models with a load of 700 N in standing and sitting positions. Biomechanical stress distributions and fracture displacements were analysed and compared between these fixation techniques. RESULTS In models simulating the standing position, high displacements and stress distributions were observed at the infra-acetabulum regions. The degree of these fracture displacements was low in the IQP (0.078 mm), as compared to either the IP-PS-IS (0.079 mm) or the SP & PP (0.413 mm) fixation constructs. However, the IP-PS-IS fixation construct had the highest effective stiffness. In models simulating the sitting position, high fracture displacements and stress distributions were observed at the regions of the anterior and posterior columns. The degree of these fracture displacements was low in the SP-PS-IS (0.101 mm), as compared to the IP-PS-IS (0.109 mm) and the SP-PP (0.196 mm) fixation constructs. CONCLUSION In both standing and sitting positions, the stability and stiffness index were comparable between the IQP, SP-PS-IS, and IP-PS-IS. These 3 fixation constructs had smaller fracture displacements than the SP-PP construct. The stress concentrations at the regions of quadrilateral surface and infra-acetabulum suggest that the buttressing fixation of quadrilateral plate was required for ACPHT fractures.
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Affiliation(s)
- Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Guixiong Huang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Yanlin Su
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China
| | - Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, Hubei, 430022, People's Republic of China.
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Wang T, Hou X, Zhou Z, Liu J, Zhang S, Ge S, Jia S, Zheng L. Treatment of acetabular fracture involving anterior and posterior columns using a single pararectus approach: surgical experience and preliminary results. INTERNATIONAL ORTHOPAEDICS 2023; 47:233-240. [PMID: 36194283 DOI: 10.1007/s00264-022-05587-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE This study aims to evaluate the efficacy of single pararectus approach in patients confirmed with acetabular fracture involving anterior and posterior columns. METHODS A total of 58 patients confirmed with acetabular fracture involving anterior and posterior columns and treated at our hospital between January 2015 and January 2020 were retrospectively analyzed. A single pararectus approach was applied for all patients. Routine X-rays were performed at follow-up of one, three, six, 12, and 18 months, and three-dimensional CT scans were added at six and 18 months. Fracture reduction quality was assessed using the Matta score system, and functional assessment used the Modified Merle D'Aubigné and Postel score system. Post-operative complications, including fat liquefaction and deep vein thrombosis, were recorded and analyzed. RESULTS The median operation time was 186 min while the intra-operative blood loss was 421 mL. The rate of good-to-excellent reduction was 94.8%, and the rate of good-to-excellent hip function score reached 93.1%. Seven patients presented with post-operative complications, including three intra-operative small vascular injuries, two peritoneal small perforations, one fat liquefaction, and one deep vein thrombosis. CONCLUSION Using a single pararectus approach is convenient and effective for treating acetabular fracture involving anterior and posterior columns, especially those involving the quadrilateral area. TRIAL REGISTRATION ChiCTR, ChiCTR2100054604. Registered 21 December 2022. Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=144783 .
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Affiliation(s)
- Tianlong Wang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiaodong Hou
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zifei Zhou
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Junfeng Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shaodi Zhang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shuo Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shaohua Jia
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Longpo Zheng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China. .,Shanghai Trauma Emergency Center, Shanghai, 200072, China. .,Orthopedic Intelligent Minimally Invasive Diagnosis & Treatment Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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Li M, Deng J, Li J, Li Z, Zhang H, Zhao Y, Zhang L, Tang P. A Novel Anatomical Locking Guide Plate for Treating Acetabular Transverse Posterior Wall Fracture: A Finite Element Analysis Study. Orthop Surg 2022; 14:2648-2656. [PMID: 36000214 PMCID: PMC9531056 DOI: 10.1111/os.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/12/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To improve the treatment of the acetabular transverse posterior wall fracture (ATPWF), a novel anatomical locking guidance plate (NALGP) was designed and compared with traditional fixations using finite element analysis. METHODS The ATPWF model was constructed using the three-dimensional finite element model of the half pelvis via the Mimics software and three internal devices were used to fix this model: the posterior-column locking plate with anterior-column screws (PCLP), double-column locking plates (DCLP), and NALGP. Next, mesh division was conducted by solid 187 tetrahedral elements in the workbench software. After defining the boundary condition and material properties, each assembly model was loaded in an increasing manner with a downward vertical force of 200, 400, and 600 N, respectively. The loading force was directed at 45 degrees upward in the coronal plane and 25 degrees backward in the sagittal plane. Finally, the stress distribution and stress peak of plates and screws were measured and evaluated, and the displacement of fracture fragments under different loading force was assessed among the three groups. RESULTS For stress distribution, it was found that the stress mainly acted on the posterior-column plate, especially concentrated at the middle and lower section of the plate in all three groups after fixation on the ATPWF. In addition, most stresses of screws appeared on the lag screws instead of the common screws. The common screws in the NALGP group experienced larger stresses under all loading force, while those in the DCLP group withstood less stresses compared to those in the PCLP group. For the displacement of fracture fragments, the NALGP group were found to have less fracture fragment displacements than the PCLP group, but had comparable results to DCLP at both the transverse fracture and the posterior wall fracture sites. CONCLUSION The newly-designed fixation device showed superiorities on fracture stabilization over PCLP, but had comparable stability to DCLP. This suggests that the DCLP might be unnecessary for treating ATPWF in some instances because it might cause bigger surgical trauma and blood loss.
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Affiliation(s)
- Ming Li
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine and RehabilitationBeijingChina
| | - Junhao Deng
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine and RehabilitationBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Jiantao Li
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine and RehabilitationBeijingChina
| | - Zhirui Li
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine and RehabilitationBeijingChina
| | - Hao Zhang
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine and RehabilitationBeijingChina
| | - Yanpeng Zhao
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine and RehabilitationBeijingChina
| | - Licheng Zhang
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine and RehabilitationBeijingChina
| | - Peifu Tang
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine and RehabilitationBeijingChina
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Khalefa MA, El Nahal WA, Abdel Karim M, Abdel-Kader KFM, Chesser TJS, Ward AJ, Acharya M. Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up. J Orthop Trauma 2022; 36:439-444. [PMID: 35302968 DOI: 10.1097/bot.0000000000002369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the results of a new plate system using anterior approaches in the management of acetabular fractures. DESIGN Retrospective case-note review. SETTING Pelvic and acetabular tertiary center. PATIENTS AND INTERVENTION A consecutive series of acetabular fractures treated using only anterior approach and anatomical plates, at one tertiary specialist unit, were reviewed. The fracture patterns, incisions used, intraoperative and postoperative complications, reduction achieved (measured on postoperative radiographs and computed tomography scans), and early postoperative results (minimum 1-year follow-up) were recorded. MAIN OUTCOME MEASUREMENT Postoperative reduction (measured by postoperative plain radiographs and computed tomography). RESULTS Thirty-three patients (mean age, 57 years) underwent reconstruction with the anatomical plates using anterior approaches. Associated both columns and anterior column posterior hemitransverse represented most of the patients (85%). The fracture pattern was complex with quadrilateral plate involvement in 79% of cases. Overall, anatomic reduction was seen in 82% on plain radiographs and CT scan evaluation. Increasing age was a statistically significant variable in obtaining anatomical reduction with an age cutoff value of 70 years ( P 0.012). Associated both column fractures were associated with a lower incidence of anatomical reduction ( P = 0.038). Complication rates were comparable with the literature. 22 patients (71%) were symptom free, with 20 patients (62.5%) having excellent radiographic outcomes at the latest follow-up. CONCLUSIONS The results suggested that using approach-specific instruments and anatomical plates through anterior approaches in a specialized unit led to anatomical reconstruction in 82% with patients demonstrating satisfactory early radiological and functional outcomes at 1 year. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mohamed A Khalefa
- Royal orthopaedic Hospital, Birmingham, United Kingdom.,Cairo University Hospitals, Cairo, Egypt; and
| | - Walid A El Nahal
- Royal orthopaedic Hospital, Birmingham, United Kingdom.,Cairo University Hospitals, Cairo, Egypt; and
| | | | | | | | - Anthony J Ward
- Pelvic and Acetabular Reconstruction Unit, North Bristol NHS Trust, Bristol, United Kingdom
| | - Mehool Acharya
- Pelvic and Acetabular Reconstruction Unit, North Bristol NHS Trust, Bristol, United Kingdom
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Wan Y, Yao S, Ma Y, Zeng L, Wang Y, Qu Y, Huang G, Guo X, Chen K. The novel infra-pectineal buttress plates used for internal fixation of elderly quadrilateral surface involved acetabular fractures. Orthop Surg 2022; 14:1583-1592. [PMID: 35706090 PMCID: PMC9363733 DOI: 10.1111/os.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives In geriatric acetabular fractures, the quadrilateral surface (QLS) was frequently involved in acetabular fracture patterns and accompanied by medial displacement. It was important to buttress the medial displaced QLS and reconstruct the congruity of the affected acetabulum. To evaluate the clinical effectiveness of the novel infra‐pectineal quadrilateral surface buttress plates for the treatment of geriatric acetabular fractures. Methods Twenty‐three geriatric patients who were treated for acetabular fractures involving QLS with the novel infra‐pectineal buttress plates (NIBP) through a single supra‐ilioinguinal approach between January 2015 and June 2019 were retrospectively analyzed; all patients received at least 1 year's follow‐up. All patients were aged ≥60 years old and including 18 males and five females. Radiologic and clinical outcomes of patients involved in the study were collated and analyzed according to the Matta scoring system and the Merle D'Aubigné–Postel scoring system. The functional recovery scoring was compared using q‐test. Results All 23 consecutive patients had relatively satisfactory clinical treatment effectiveness. Average ages, length of incision, operation time, and intraoperative blood loss were 69.8 ± 6.1 years, 12.1 ± 2.6 cm, 166.5 ± 43.5 min, and 500 (500,700) ml, respectively. According to the Matta scoring system, 14 cases of reduction were graded as excellent, five as good, and four as fair. At the last follow‐up, the clinical outcome evaluation was excellent in 13 cases, good in seven cases, and poor in three cases with the use of the Merle D'Aubigné–Postel scoring system. The difference of modified Merle D'Aubigne‐Postel score at 3 months, 6 months and last follow up was statistically significant (F = 21.56, p < 0.05). Postoperative lateral femoral cutaneous nerve injury occurred in three patients and heterotopic ossification occurred in one patient. Conclusions For the treatment of geriatric acetabular fractures, the NIBP could provide stable and effective fixation to the QLS involved acetabular fractures, and related satisfactory clinical results with few complications were noted.
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Affiliation(s)
- Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yan Ma
- The second clinical medical college, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yulong Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yanzhen Qu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Guixiong Huang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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20
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Chen Z, Wu ZX, Chen G, Ou Y, Wen HJ. Oblique-ilioischial plate technique: a novel method for acetabular fractures involving low posterior column. BMC Musculoskelet Disord 2022; 23:540. [PMID: 35668428 PMCID: PMC9169395 DOI: 10.1186/s12891-022-05487-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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21
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Gökgöz MB, Alemdaroğlu B, Özmeriç A, İltar S, Erbay FK, Demir T. The Effect of Lateralization of a Pelvic Brim Plate on the Fixation of an Anterior Column Fracture: A Biomechanical Analysis. Cureus 2022; 14:e24158. [PMID: 35592198 PMCID: PMC9110042 DOI: 10.7759/cureus.24158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
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22
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Treatment of acetabular fractures with quadrilateral plate injury - a comparison of two commonly used methods. Orthop Traumatol Surg Res 2022; 108:102951. [PMID: 33932577 DOI: 10.1016/j.otsr.2021.102951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/01/2020] [Accepted: 12/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acetabular fractures with quadrilateral plate (QLP) involvement have traditionally been treated by buttress plates applied through an Ilio-inguinal approach. Recently, many surgeons prefer the application of infra-pectineal plates through the modified Stoppa approach for this purpose. Whether one method can be preferred over the other is a matter of investigation. HYPOTHESIS The research question was whether an infra pectineal plate applied through the modified Stoppa approach for acetabular fractures with QLP involvement would result in an equivalent or better outcome than a buttress plate applied through an ilioinguinal approach. PATIENTS AND METHODS This was a retrospective study of patients with QLP fractures operated by either of the two methods and who had completed at least one year follow up. Demographic and surgical details and the radiological and clinical outcomes at the last follow-up visit were obtained from patient records. RESULTS A total of 41 patients were treated with a buttress plate applied through an ilioinguinal approach (group A), and 49 patients were treated with an infra-pectineal plate by the modified Stoppa approach (group B). Duration of surgery and intra-operative blood loss was significantly less in group B patients. Radiological and clinical outcomes were better in group B patients than group A patients. Implant loosening was more frequent in group A patients. Injury to the obturator vessels were more common in group B patients. CONCLUSION With a comparatively lesser surgical duration and blood loss, better clinical and radiological outcomes at least one year after the surgery, an infra-pectineal plate applied through the modified Stoppa approach can be considered the preferred treatment for most acetabular fractures with QLP involvement. LEVEL OF EVIDENCE III.
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23
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Hinz N, Dehoust J, Münch M, Seide K, Barth T, Schulz AP, Frosch KH, Hartel MJ. Biomechanical analysis of fixation methods in acetabular fractures: a systematic review of test setups. Eur J Trauma Emerg Surg 2022; 48:3541-3560. [PMID: 35305114 PMCID: PMC9532317 DOI: 10.1007/s00068-022-01936-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose Optimal anatomical reduction and stable fixation of acetabular fractures are important in avoiding secondary dislocation and osteoarthritis. Biomechanical studies of treatment options of acetabular fractures aim to evaluate the biomechanical properties of different fixation methods. As the setup of the biomechanical test can influence the experimental results, this review aimed to analyze the characteristics, comparability and clinical implications of studies on biomechanical test setups and finite element analyses in the fixation of acetabular fractures. Methods A systematic literature research was conducted according to the PRISMA guidelines, using the PubMed/MEDLINE and Web of Science databases. 44 studies conducting biomechanical analyses of fixation of acetabular fractures were identified, which met the predefined inclusion and exclusion criteria and which were published in English between 2000 and April 16, 2021. The studies were analyzed with respect to distinct parameters, including fracture type, material of pelvis model, investigated fixation construct, loading direction, loading protocol, maximum loading force, outcome parameter and measurement method. Results In summary, there was no standardized test setup within the studies on fixation constructs for acetabular fractures. It is therefore difficult to compare the studies directly, as they employ a variety of different test parameters. Furthermore, the clinical implications of the biomechanical studies should be scrutinized, since several test parameters were not based on observations of the human physiology. Conclusion The limited comparability and restricted clinical implications should be kept in mind when interpreting the results of biomechanical studies and when designing test setups to evaluate fixation methods for acetabular fractures. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01936-9.
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Affiliation(s)
- Nico Hinz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Matthias Münch
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Klaus Seide
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Tobias Barth
- Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Arndt-Peter Schulz
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Mönkhofer Weg 239 a, 23562, Lübeck, Germany
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma Surgery, Orthopedic and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany. .,Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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24
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Guo J, Dong W, Zhou Y, Hu J, Ye P, Chen W, Zhang Y, Hou Z. Differences in fixation to young and elderly quadrilateral surfaces with anatomic quadrilateral surface plate (AQSP) based on cortical thickness morphological results. J Orthop Surg Res 2022; 17:143. [PMID: 35248102 PMCID: PMC8898526 DOI: 10.1186/s13018-022-03027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS With relatively thinner cortical thickness, the management of acetabulum osteoporotic fractures in elderly patients is difficult. The aim of the research was to compare and present the morphological characteristics of the quadrilateral plate in young and elderly age groups, such as the area, and position distribution of the thin cortical thickness region, fracture lines maps, and propose a revised design plate for elderly patients based on these anatomic information. METHODS As a retrospective research, acetabular fracture with one normal hemipelvises, including 110 men and 39 women, were collected to present the morphological characteristics of the quadrilateral region. The subjects were divided into three different age groups: Group I = 18-40 years (31.3 ± 6.6 years), Group II = 41-60 years (49.9 ± 5.3 years), and Group III ≥ 61 years (68.7 ± 6.8 years). The area of the quadrilateral surface, the area and position distribution of the thin cortical thickness region, the ratio and fracture lines maps were calculated and compared with Mimics in different groups. RESULTS The thin cortical thickness/width region area (TCWRA) was significantly increased in Group III compared with Group I and Group II. The ratio of TCWRA accounted for in the quadrilateral region was also significantly increased in Group III (≥ 61 years) compared with Group I (P = 0.01) and Group II (P = 0.011). None of the subjects had a component involving the "A" zone, thirty-three thin cortical thickness regions were located in the "B" zone, and one hundred and sixteen involved both zones of the quadrilateral plate ("A + B" zone). Furthermore, there were a significant differences in the fracture line distributions in three age groups. More fracture lines of elderly patients were located at anterior part (B zone) compared with Group I and Group II. CONCLUSIONS It was identified the area of thin cortical thickness region increased as age grown, and fracture lines were inclined to be more distributed in "B" zone in elderly patients. To meet the demands of acetabular fixation in different age groups, cortical thickness changes in young and elderly individuals should be given special attention when the quadrilateral surface plate is designed. Level of evidence Level IV, observational study.
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Affiliation(s)
- Jialiang Guo
- The School of Medicine, Nankai University, Tianjin, People's Republic of China
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Weichong Dong
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yali Zhou
- The School of Medicine, Nankai University, Tianjin, People's Republic of China
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Jinglue Hu
- The School of Medicine, Nankai University, Tianjin, People's Republic of China
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Pengyu Ye
- The School of Medicine, Nankai University, Tianjin, People's Republic of China
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wei Chen
- The School of Medicine, Nankai University, Tianjin, People's Republic of China
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- The School of Medicine, Nankai University, Tianjin, People's Republic of China.
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
- Chinese Academy of Engineering, Beijing, People's Republic of China.
| | - Zhiyong Hou
- The School of Medicine, Nankai University, Tianjin, People's Republic of China.
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
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25
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Osterhoff G, Reise R, Riemer E, Höch A, Fakler JKM, Heyde CE, Schleifenbaum S. The pectineal ligament is a secondary stabilizer in anterior pelvic ring fractures - a biomechanical study. Injury 2022; 53:334-338. [PMID: 34920874 DOI: 10.1016/j.injury.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/27/2021] [Accepted: 12/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is ongoing discussion whether operative fixation of partially stable lateral compression fractures of the pelvis is beneficial for the patient. Recent studies suggest that the pectineal ligament may act as a secondary stabilizer of the anterior pelvis ring. The purpose of this study was to investigate the influence of the pectineal ligament's integrity on the biomechanical stability and displacement in anterior pelvic ring fractures. METHODS In a biomechanical setup, a cyclic loading protocol was applied with sinusoidal axial force from 100 to 500 N on cadaver hemipelves with soft tissues (n = 5). After testing the native specimens ("No fracture"), increasing degrees of injury were created on the samples: 1. an osseous defect to the pubic ramus ("Bone #"), 2. cutting of all soft tissues including obturator membrane except for the pectineal ligament intact ("ObtM #"), 3. cutting of the pectineal ligament ("PectL #") - with the loading protocol being applied to each sample at each state of injury. Fracture motion and vertical displacement were measured using a digital image correlation system and opto-metric analysis. RESULTS No failure of the constructs was observed. Creating a pubic ramus fracture (p = 0.042) and cutting the pectineal ligament (p = 0.042) each significantly increased relative fracture movement. The mean change in absolute movement was 0.067 mm (range, 0.02 mm to 0.19 mm) for ObtM # and 0.648 mm (range, 0.07 mm to 2.93 mm), for PectL # in relation to Bone # (p = 0.043). Also for absolute vertical movement, there was a significant change when the pectineal ligament was cut (p = 0.043), while there was no such effect with cutting all other soft tissues including the obturator membrane. CONCLUSIONS Based on the findings of this in vitro study, the pectineal ligament significantly contributes to the stability of the anterior pelvic ring. An intact pectineal ligament reduces fracture movement in presence of a pubic ramus fracture.
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Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
| | - Rebekka Reise
- Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Elena Riemer
- Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Andreas Höch
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Johannes K M Fakler
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany; Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
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Zhou XF, Gu SC, Zhu WB, Yang JZ, Xu L, Fang SY. Quadrilateral plate fractures of the acetabulum: Classification, approach, implant therapy and related research progress. World J Clin Cases 2022; 10:412-425. [PMID: 35097066 PMCID: PMC8771372 DOI: 10.12998/wjcc.v10.i2.412] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/29/2021] [Accepted: 12/02/2021] [Indexed: 02/06/2023] Open
Abstract
The quadrilateral plate (QP) is an essential structure of the inner wall of the acetabulum, an important weight-bearing joint of the human body, which is often involved in acetabular fractures. The operative exposure, reduction and fixation of QP fractures have always been the difficulties in orthopedics due to the special morphological structure and anatomical features of the QP. Fortunately, there have been many effective methods and instruments developed for QP exposure, reduction and fixation by virtue of the combined efforts of numerous orthopedists. At the same time, each method presents with its own advantages and disadvantages, resulting in different prognoses. It is necessary to have a thorough understanding of the anatomy, radiology and fixation techniques of the QP in terms of patient prognosis optimization. In this paper, the anatomical features, definition and classification of QP, operative approach selection, implant internal fixation methods and efficacy were reviewed.
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Affiliation(s)
- Xue-Feng Zhou
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
- Graduate School, Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Si-Chao Gu
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - Wan-Bo Zhu
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - Jia-Zhao Yang
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - Lei Xu
- Department of Traumatic Orthopedics, The First Affiliated Hospital of USTC, Hefei 230001, Anhui Province, China
| | - Shi-Yuan Fang
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230000, Anhui Province, China
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Cha Y, Yoo JI, Kim JT, Park CH, Choy WS. How to Solve Anatomical Mismatch in Fixation of Acetabular Fractures Using an Anatomical Quadrilateral Surface Plate. Clin Orthop Surg 2022; 15:338-342. [PMID: 37008975 PMCID: PMC10060771 DOI: 10.4055/cios22169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
The anatomical quadrilateral surface buttress plate developed for the quadrilateral surface in an acetabular fracture, a type of fracture difficult to reduce using screws and plates due to its thinness, is a useful implant that makes surgical treatment easier. However, the anatomical structure is different for each patient, and it often does not match the contour of this plate, making detailed bending difficult. Here, we introduce a simple method for controlling the degree of reduction using this plate.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
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The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate. Arch Orthop Trauma Surg 2022; 142:1539-1546. [PMID: 33760940 PMCID: PMC9217777 DOI: 10.1007/s00402-021-03867-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures. PATIENTS AND METHODS A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography. RESULTS Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty. CONCLUSION A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.
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Ciolli G, De Mauro D, Rovere G, Smakaj A, Marino S, Are L, El Ezzo O, Liuzza F. Anterior intrapelvic approach and suprapectineal quadrilateral surface plate for acetabular fractures with anterior involvement: a retrospective study of 34 patients. BMC Musculoskelet Disord 2021; 22:1060. [PMID: 34969392 PMCID: PMC8717694 DOI: 10.1186/s12891-021-04908-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the study is to evaluate the use of the suprapectineal quadrilateral surface (QLS) plates associated with the anterior intrapelvic approach (AIP) to the acetabulum in the surgical treatment of acetabular fractures with anterior involvement. METHODS We did a retrospective study of patients surgically treated with QLS plates and AIP for acetabular fractures with the involvement of the anterior column, between February 2018 and February 2020, in our Hospital. The following data were recorded: mechanism of injury, the pattern of fracture, presence of other associated injuries, the time before performing the surgery, surgical approach, position on operating table, time of surgery, intraoperative bleeding, hospitalization time, intraoperative and postoperative complications. Follow-ups were performed at 1, 3, 6, 12 months, then annually. The clinical-functional outcome was assessed with the Merle d'Aubigne Postel score (MAP) modified by Matta; while the radiological outcome with the Matta Radiological Scoring System (MRSS). A Chi-square test was utilized to examine associations between parametric variables. RESULTS We included 34 patients, mean age 62.1, with an average follow-up of 20.7 months. The most frequent traumatic mechanism was road trauma. There were 15 isolated anterior columns and 19 associated patterns. There were 5 cases of associated visceral injuries, and 10 cases of other associated skeletal fractures. All patients were in the supine position. The surgical approach used was the AIP in all cases, with the addition of the first window of the ilioinguinal approach in 16 cases and of the Kocher-Langenbeck approach in 2 cases. The average time before performing the surgery was 8.5 days. The mean time of the surgery and the mean length of stay after surgery were 227.9 min and 8.2 days, respectively. There weren't cases of intra-operative complications, while there were postoperative complications in 5 patients. The MRSS was judged anatomical in 26 cases, imperfect in 7 cases and poor in 1 case. The average MAP value was 15.2. We observed a significant relationship between the radiological outcome and the clinical outcome (p < 0.05). CONCLUSIONS The QLS plates in association with the AIP approach represent an effective treatment strategy for the treatment of acetabular fractures with anterior involvement.
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Affiliation(s)
- Gianluca Ciolli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico De Mauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Marino
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Are
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Omar El Ezzo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Liuzza
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A, Gemelli IRCCS Largo Agostino Gemelli, 8, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
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Freigang V, Gottsauner M, Rupp M, Pfeifer C, Grechenig S, Kerner A, Alt V, Baumann F. Surgical Drill Guide for Insertion of an Infra-Acetabular Screw Based on an Anatomically Precontoured Plate System: A Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2321504. [PMID: 34355040 PMCID: PMC8331300 DOI: 10.1155/2021/2321504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/03/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Due to the anatomic structure of the pelvis, free-hand placement of screws in the acetabular fracture management can be difficult. Infra-acetabular screw fixation increases acetabular stability by distal fixation of the cup. Aim of this cadaveric study is to investigate if a plate-referenced drill guide can provide save placement of an infra-acetabular screw over a precontoured suprapectineal quadrilateral buttress plate (SQBP). METHODS We constructed a drill guide for an infra-acetabular screw based on the surface of an anatomically precontoured SQBP. A total of 12 adult cadaveric acetabular specimens were used for drill guide-assisted placement of the infra-acetabular screw. The drill guide contains a radiopaque spiral to allow longitudinal fine adjustment of the SQBP along the pelvic brim to assure correct position of the plate-drill-guide construct in relation to the Koehler's teardrop. After screw placement, we conducted a computed tomography (CT) scan of all specimens to assess the actual position of the screw in relation of the infra-acetabular corridor and the acetabular joint surface. RESULTS The position of the screw was within the infra-acetabular corridor in all cases. We did not see any intra-articular or intrapelvic screw penetration. The mean distance of the centerline of the screw to the medial border of the infra-acetabular corridor was 3.35 mm. The secure distance to the virtual surface of the femoral head to was 7.3 mm. CONCLUSIONS A plate-referenced drill guide can provide safe placement of an infra-acetabular screw for treatment of acetabular fractures. Radiographic fine adjustment is necessary to access the optimal entry point.
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Affiliation(s)
- Viola Freigang
- Department of Trauma Surgery, Regensburg University Medical Center, Germany
| | - Maximilian Gottsauner
- Department of Cranio-Maxillofascial Surgery, Regensburg University Medical Center, Germany
| | - Markus Rupp
- Department of Trauma Surgery, Regensburg University Medical Center, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, Regensburg University Medical Center, Germany
| | - Stephan Grechenig
- Department of Trauma Surgery, Regensburg University Medical Center, Germany
| | | | - Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, Germany
| | - Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, Germany
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Boudissa M, Porcheron G, Nowak T, Hofmann A, Wagner D, Rommens PM. Quadrilateral Surface Restoration by Medial Buttressing Before Revision in Periprosthetic Acetabular Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00033. [PMID: 33861728 DOI: 10.2106/jbjs.cc.20.00927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of periprosthetic acetabular fracture with pelvic discontinuity (PAFPD) classified Paprosky IIIb around an infected hip resurfacing prosthesis. A 3-stage revision was performed with (1) implants removal and surgical debridement to treat the infection; (2) open reduction and internal fixation using a medial buttress plate to treat pelvic discontinuity; and (3) custom-made total hip replacement with acetabular-ring reinforcement. The patient recovered with excellent clinical and radiographic results at 4-year follow-up. CONCLUSIONS In complex cases of PAFPD, a collaboration between pelvic trauma surgeons and orthopaedic hip surgeons allows to provide stability for revision surgeries with good outcomes.
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Affiliation(s)
- Mehdi Boudissa
- Department of Orthopaedics and Traumatology, University Medical Center Mainz, Langenbeckstrasse, Mainz, Germany
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Yao S, Chen K, Zhu F, Liu J, Wang Y, Zeng L, Wan Y, Qu Y, Yang L, Guo X, Yang X. Internal fixation of anterior acetabular fractures with a limited pararectus approach and the anatomical plates: preliminary results. BMC Musculoskelet Disord 2021; 22:203. [PMID: 33602187 PMCID: PMC7891165 DOI: 10.1186/s12891-021-04034-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/31/2021] [Indexed: 01/17/2023] Open
Abstract
Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 min and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively. Conclusions The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04034-w.
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Affiliation(s)
- Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengzhao Zhu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yulong Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yizhou Wan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanzhen Qu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xu Yang
- Department of Orthopaedics, Suizhou Hospital, Hubei university of medicine, Suizhou, China.
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Sen RK, Saini G, Kadam S, Raman N. Anatomical quadrilateral plate for acetabulum fractures involving quadrilateral surface: A review. J Clin Orthop Trauma 2020; 11:1072-1081. [PMID: 33192011 PMCID: PMC7656483 DOI: 10.1016/j.jcot.2020.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The management of acetabulum fractures in osteoporotic elderly, as well as comminuted fractures in younger patients is likely to be difficult. These fractures need specific fixation techniques especially when the quadrilateral plate is involved. Standard implants may not be able to adequately support the fixation, so newer pre-shaped fixation plates have been proposed with some of these already in use. The concept of anatomic plates has come up for many fracture locations for providing a better buttress effect to the comminuted fragments. There has been a need to look for an anatomic buttress plates being developed for acetabulum fractures involving the quadrilateral surface. MATERIALS AND METHODS The literature has been reviewed to find the various newer designs that have been used for buttressing the quadrilateral surface in comminuted acetabular fractures. An attempt has been made to study their design characteristics and clinical outcomes. The review also includes the analysis of Anatomic Quadrilateral plate (AQP) used in fixation of acetabulum fracture involving quadrilateral surface in a series of 33 patients. RESULTS There has been few anatomical plates developed for the stabilization of acetabular quadrilateral surface fractures. Some of these plates have been successfully used in management of acetabular fractures primarily in young patients. Issues however remain in their application and outcomes in osteoporotic fractures of the acetabulum, as these plates support the pelvic brim fragments either from superior or medial surface. The newer development i.e. 'Anatomical Quadrilateral Plate' is optimized to counter the displacement forces due to its positioning on the pelvic brim rather than its superior or medial surface. Other special features include the possibility of longer screws across bone due to oblique position of holes, the typical location of a locking hole on the plate beam which permits dual cortical compression fixation either by using a bigger screw or a specially designed screw in screw construct across the supra-acetabular corridor. The option of using hybrid fixation of both locking and unlocked screws in AQP allows proper stress distribution on the underlying bone, aiding both primary as well as secondary stability. The minimum of one year post surgery outcome of patients having acetabular fixation using this Anatomic quadrilateral plate has been analyzed in 33 patients. Twenty three of these were aged more than 50 years and 28 out of total 33 were males. Associated injuries included Ipsilateral lower limb injury in 2 patients and distal radius fracture in 5 patients. The fracture pattern included 'Anterior column posterior hemi-transverse' in 10 patients,' Associated Both Column' injury in 9 and 'T type' acetabular fractures in 8 patients. Isolated 'Anterior column' was fractured in 6 patients. The surgical approach was 'Anterior Intra-pelvic' (AIP) in 23 patients and 'Modified Ileo-femoral' in other 10 patients. One patient had additional K L approach. Among the implants, the AQP plate was used without its pubic arm in 6 patients. The post-operative x rays showed anatomical reduction in 28 patients, while other 5 had gaps and/or steps up to 2 mm size. In subsequent car, one of these patients needed hip arthroplasty for problem arising due to collapse in fixation within six months. EQ 5D 5L telephonic score was used to know the outcome at minimum of one year follow up in 33 patients. As per this score, only 3 patients had an issue with mobility, with only one having problem in self-care activity. Six patients complained of minor limitations in carrying out their usual activities and only one patient had anxiety affecting him. In their self-assessment of overall health status, 22 patients marked it 100, 7 made it 90, 3 as 80 and 1 had marked it as 70 in a score range of 0-100. Considering the predominant elderly profile in this series of patients, the acetabular reconstruction using 'Anatomic quadrilateral plate' has shown encouraging results. CONCLUSION For stabilization of acetabular fractures involving quadrilateral surface area and pelvic brim, various new implants have been used. The Anatomic quadrilateral plate due to its anatomical shape, the various options in fracture fixation is best optimized for management of comminuted acetabulum fractures especially in poor quality bones. It has been successful in achieving good outcome in elderly group of patients having these complex injuries.
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Affiliation(s)
- Ramesh K. Sen
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Gaurav Saini
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Sagar Kadam
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
| | - Neha Raman
- Institute of Orthopaedics, Max Hospital, 5439,38 West Chandigarh, Mohali, 160014, Punjab, India
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Nicol G, Sanders E, Liew A, Wilkin G, Gofton WT, Papp S, Grammatopoulos G. Does use of a quadrilateral surface plate improve outcome in elderly acetabular fractures? J Clin Orthop Trauma 2020; 11:1045-1052. [PMID: 33192008 PMCID: PMC7656488 DOI: 10.1016/j.jcot.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/22/2020] [Accepted: 10/02/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Acetabular fractures in the elderly frequently involve segmental quadrilateral plate injury, yet no consensus exists on how to best control the femoral head medial displacement. Quadrilateral surface plates (QSP) were developed to help buttress these challenging fractures. The study aims to 1) Determine the prevalence of segmental quadrilateral plate fractures (SQPF) in elderly patients; and 2) Assess if utilization of a QSP is associated with improved acetabulum fracture reduction and outcome. METHODS This was a retrospective study conducted at a level-1 trauma centre. . All patients over 60-years that sustained an acetabular fracture between 2007 and 2019 were reviewed. Pre-operative pelvic radiographs and CT imaging were reviewed for 96 patients, to assess for SQPF. From the 96 patients reviewed, over one third of patients (n = 40, 41.6%) sustained a SQPF. Patients that had an acute-THA (n = 7) were excluded as were patients that underwent an ORIF but did not have a QSP or an anterior column buttress plate (n = 3). The remaining 30 formed the study's cohort. We assessed the ability to achieve and maintain reduction in this elderly population, and compared outcomes using traditional anterior column buttress plates (ilioingual or intra-pelvic approach) versus an intra-pelvic pre-contoured buttress suprapectineal plate (QSP). Outcome measures included: fracture reduction using the Matta classification (desirable: anatomical/imperfect and poor), re-operations, conversion to THA and Oxford Hip Score (OHS) (for the preserved hips). RESULTS Ten patients had an ORIF with utilization of a QSP (QSP-group), and 20 had an ORIF but did not have the QSP (non-QSP-group). There was no difference in patient demographics between groups. Fracture patterns were also similar (p = 0.6). Postoperative fracture reduction was desirable (anatomical/imperfect) in 17 patients and poor in 13. Improved ability to achieve a desirable reduction was seen in the QSP-group (p = 0.02). Conversion to THA was significantly lower in patients that had a desirable fracture reduction (appropriate: 3/17; poor: 7/13). No patients in the QSP-group have required a THA to-date, compared to 10/20 patients in the non-QSP-group (p = 0.01). The mean time to THA was 1.6 ± 2.1 year. There was no difference in OHS between the two groups (34.4 ± 10.3). CONCLUSION Elderly acetabulum fractures have a high incidence (approaching 40%) of segmental QPF. Desirable (anatomical/imperfect) fracture reduction was associated with improved outcome. The use of a QSP was associated with improved ability to achieve an appropriate reduction. A QSP should be considered as they are both reliable and reproducible with a significantly improved fracture reduction and lower conversion to THA.
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Affiliation(s)
- Graeme Nicol
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ethan Sanders
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Allan Liew
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Geoffrey Wilkin
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Wade T. Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Steven Papp
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Le Quang H, Schmoelz W, Lindtner RA, Schwendinger P, Blauth M, Krappinger D. Biomechanical comparison of fixation techniques for transverse acetabular fractures - Single-leg stance vs. sit-to-stand loading. Injury 2020; 51:2158-2164. [PMID: 32646647 DOI: 10.1016/j.injury.2020.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To biomechanically compare five different fixation techniques for transverse acetabular fractures using both the single-leg stance (SLS) and the sit-to-stand (STS) loading protocols and to directly compare fracture gap motion (FGM) and relative interfragmentary rotation (RIFR). METHODS Transtectal transverse acetabular fractures were created on fourth-generation composite hemipelves in a reproducible manner. Five different fixation techniques were biomechanically assessed using both an SLS and STS loading protocol: anterior plate (AP) only, posterior plate (PP) only, anterior plate plus posterior column screw (AP+PCS), posterior plate plus anterior column screw (PP+ACS) and anterior plus posterior plate (AP+PP). After preconditioning, the specimens were loaded from 50 to 750 N with a ramp of 100 N/s. FGM and RIFR under loads of 750 N were measured using an optical 3D measurement system. RESULTS In the three groups of fixation techniques addressing both columns, STS loading resulted in higher mean FGM and in RIFR than SLS loading. No construct failure was observed. In the single plate groups (AP only and PP only), STS loading resulted in failure of all specimens before reaching loads of 750 N, while no failure occurred after SLS loading. No significant differences in FGM and RIFR were found between the double plate (AP+PP) and the single plate plus column screw (AP+PCS and PP+ACS) techniques. CONCLUSION SLS loading appeared to overestimate the strength of acetabular fracture fixation constructs and STS loading may be more appropriate to provide clinically relevant biomechanical data. Internal fixation of a single column might not provide adequate stability for transverse fractures, while strength of single plate plus column screw fixation and double plate fixation was comparable.
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Affiliation(s)
- Huy Le Quang
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Richard A Lindtner
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Peter Schwendinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Michael Blauth
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
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Chen K, Yang F, Yao S, Xiong Z, Sun T, Guo X. Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly: The Role of Special Quadrilateral Surface Buttress Plates. J Bone Joint Surg Am 2020; 102:e81. [PMID: 32675678 PMCID: PMC7508287 DOI: 10.2106/jbjs.19.01027] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior column-posterior hemitransverse fractures are prevalent in the elderly and are often associated with quadrilateral surface (QLS) comminution. Several special QLS buttress plates have been introduced, but evidence of their comparability with traditional fixation devices is lacking. This biomechanical study aimed to compare special QLS buttress plates with traditional fixation devices. METHODS Anterior column-posterior hemitransverse fractures with an isolated QLS fragment were created on 24 composite hemipelves and were allocated to 4 fixation groups: (1) infrapectineal QLS buttress plate, (2) suprapectineal QLS buttress plate, (3) suprapectineal reconstruction plate with 3 periarticular long screws, and (4) infrapectineal reconstruction plate with 3 periarticular long screws. Specimens were loaded to simulate partial weight-bearing (35 to 350 N) or full weight-bearing (75 to 750 N). A testing machine was synchronized with a 3-dimensional video tracking system to optically track displacement at the points of interest and to calculate construct stiffness. The fixation systems were compared using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS The experimental results of the partial and full weight-bearing simulations were surprisingly similar. During 40 loading cycles, the maximum displacement on the 6 predetermined points did not exceed 1.1 mm. Multiple-group comparisons of relative displacements of each predetermined measurement point did not differ significantly (p > 0.05). The suprapectineal reconstruction plate with 3 periarticular long screws demonstrated the greatest construct stiffness and significantly greater stiffness than the infrapectineal plate with long screws (p < 0.017). However, no significant difference (p > 0.017) in stiffness was identified between the infrapectineal QLS buttress plate and the suprapectineal reconstruction plate with long screws. CONCLUSIONS The suprapectineal pelvic brim plate with 3 periarticular long screws remains the gold standard to treat anterior column-posterior hemitransverse fractures. The special infrapectineal QLS buttress plate provides stiffness and stability comparable with those of standard fixation. However, moving the pelvic brim plate from the suprapectineal border to the infrapectineal border is not recommended for anterior column-posterior hemitransverse fractures because it significantly decreases fixation stiffness. CLINICAL RELEVANCE Special QLS buttress plates may be an alternative fixation method for anterior column-posterior hemitransverse acetabular fractures in the elderly, especially when a less invasive anterior intrapelvic approach is selected.
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Affiliation(s)
- Kaifang Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People’s Republic of China
| | - Fan Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People’s Republic of China
| | - Sheng Yao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People’s Republic of China
| | - Zekang Xiong
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People’s Republic of China
| | - Tingfang Sun
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People’s Republic of China
| | - Xiaodong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People’s Republic of China,Email address for X. Guo:
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Wang C, Chen Y, Wang L, Wang D, Gu C, Lin X, Liu H, Chen J, Wen X, Liu Y, Huang F, Yao L, Fan S, Huang W, Dong J. Three-dimensional printing of patient-specific plates for the treatment of acetabular fractures involving quadrilateral plate disruption. BMC Musculoskelet Disord 2020; 21:451. [PMID: 32650750 PMCID: PMC7350601 DOI: 10.1186/s12891-020-03370-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/27/2020] [Indexed: 01/21/2023] Open
Abstract
Background Complicated acetabular fractures comprise the most challenging field for orthopedists. The purpose of this study was to develop three-dimensional printed patient-specific (3DPPS) Ti-6Al-4 V plates to treat complicated acetabular fractures involving quadrilateral plate (QLP) disruption and to evaluate their efficacy. Methods Fifty patients with acetabular fractures involving QLP disruption were selected between January 2016 and June 2017. Patients were divided into a control group (Group A, 35 patients) and an experimental group (Group B, 15 patients), and were treated by the conventional method of shaping reconstruction plates or with 3DPPS Ti-6AL-4 V plates, respectively. The efficacy of Ti-6AL-4 V plates was evaluated by blood loss, operative time, reduction quality, postoperative residual displacement, and complications. Results The operative time and blood loss in Group B were reduced compared to Group A, and the difference was statistically significant (P < 0.05). There was no significant difference in reduction quality between the two groups (P > 0.05). Reduction quality in Group B was anatomic in 10 (66.7%), satisfactory in four (26.7%), and poor in one (6.7%). In Group A, they were anatomic in 18 (51.4%), satisfactory in 13 (37.1%), and poor in four (11.4%). Residual displacement in Group B was less than that in Group A, and the difference was statistically significant (P < 0.05). In Group B, one case exhibited loosening of the pubic screw postoperatively. In Group A, there was one case of wound infection, one of deep vein thrombosis (DVT) in the ipsilateral lower limb, one case of traumatic arthritis and two obturator nerve injuries. Conclusions The 3DPPS Ti-6AL-4 V plate is a feasible, accurate and effective implant for acetabular fracture treatment.
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Affiliation(s)
- Canbin Wang
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China.,The First People's Hospital of Foshan, Foshan, 528200, China
| | - Yuhui Chen
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Liping Wang
- Department of Hand Surgery, and Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China.,UniSA Clinical & Health Sciences, and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia
| | - Di Wang
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Cheng Gu
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Xuezhi Lin
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Han Liu
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Jiahui Chen
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Xiangyuan Wen
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Yuancheng Liu
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Fuming Huang
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China
| | - Lufeng Yao
- Department of Hand Surgery, and Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China
| | - Shicai Fan
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China.
| | - Wenhua Huang
- The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou, 510600, Guangdong, China. .,School of Basic Medical Sciences, Southern Medical University, No.1023 - No.1063 Shatai South Road, Guangzhou, 510515, Guangdong, China.
| | - Jianghui Dong
- Department of Hand Surgery, and Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China. .,UniSA Clinical & Health Sciences, and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.
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Wu H, Shang R, Liu X, Song C, Chen Y, Cai X. A novel anatomically pre-contoured side-specific titanium plate versus the reconstruction plate for quadrilateral plate fractures of the acetabulum: a propensity-matched cohort study. J Orthop Surg Res 2020; 15:172. [PMID: 32408887 PMCID: PMC7222331 DOI: 10.1186/s13018-020-01659-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
Background Surgical treatment of acetabular fractures involving a quadrilateral plate is a challenge to orthopedic surgeons. We have developed a novel fixation technique using a specially shaped reconstruction plate combined with several buttress screws of a quadrilateral plate which was also called a dynamic anterior plate-screw system for quadrilateral plate (DAPSQ) to treat acetabular fractures involving quadrilateral plate since 2005 (RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, standardized titanium plate (STP group) of DAPSQ have been designed and applied. The aim of the study was to compare the clinical efficacy of anatomical plate and the reconstruction plate of DAPSQ in the treatment of quadrilateral plate fractures. Methods We led a propensity-matched cohort study of quadrilateral plate fractures. Twenty-two patients were included in the STP group during the inclusion period (2016–2018) and were matched to 22 cases in our database of the RP group (2008–2016). The primary outcome measures were the quality of reduction and functional outcomes. Intraoperative conditions were also compared. Results Of these 22 consecutive patients in the STP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture (12 cases, 54.5%) according to Letournel-Judet classification. The mean follow-up period was 23.1 months (range 12–37). There were no significant differences between the two groups with regard to the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d’Aubigné score (P > 0.05). Compared with the RP group, the STP group had a shorter operation time (245.1 min vs. 286.8 min, P = 0.020), less intraoperative blood loss (1136.4 mL vs. 1777.3 mL, P = 0.014), and transfusion (780.9 vs. 1256.8 mL, P = 0.035). The complication rate was 18.2% in the STP group, and there was no significant difference compared with the RP group (36.4%) (P > 0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure. Conclusions The fixation of standardized titanium plate in quadrilateral plate fractures showed a similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. The standardized titanium plate of DAPSQ has the advantages of a short operation time, less intraoperative bleeding, and blood transfusion, and it is worth further promotion and research.
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Affiliation(s)
- Haiyang Wu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.,Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Ranran Shang
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Chengjing Song
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Yanzhao Chen
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Xianhua Cai
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
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Fixation of Transverse Acetabular Fractures With Precontoured Plates Alone Causes Fracture Malreduction: A Biomechanical Assessment. J Orthop Trauma 2020; 34:89-94. [PMID: 31567698 DOI: 10.1097/bot.0000000000001637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Precontoured quadrilateral surface buttress (PQSB) plates have grown in popularity for acetabular fracture fixation. However, our experience has pushed us to hypothesize that their use as sole means of fixation may cause fracture malreduction. A biomechanical model was created to investigate this theory. METHODS A transverse acetabular fracture was created and reduced anatomically in 18 synthetic hemipelvises. The reduced hemipelvises were fixated using 3 different techniques. Group A fixation included anterior and posterior column screws plus a suprapectineal pelvic reconstruction plate; group B models were fixed using a PQSB plate only; and group C models were fixed with an anterior column screw and a PQSB plate. Acetabular tracking points were placed before final fixation and used to quantify any postfixation displacement. One-way analysis of variance and Tukey HSD testing were used to determine the significant difference (P < 0.05). RESULTS Models in group B had significant fracture displacement after final fixation when compared with group A and group C models. The average amount of displacement at the anterior column and within the acetabulum was 1.37 mm (95% CI, 1.08-1.65) in group B constructs compared with 0.32 mm (95% CI, 0.22-0.42) and 0.26 mm (95% CI, 0.15-0.38) in groups A and C constructs, respectively. There were no significant differences in displacement after final fixation between group A and group C models. CONCLUSIONS PQSB plates for acetabular fractures cause malreduction when applied in isolation in this biomechanical model. If a PQSB plate is chosen for fixation, we suggest the use of a columnar lag screw at minimum to hold reduction before plate application.
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Osterhoff G, Wulsten D, Babu S, Heyland M, Pari C. Antegrade versus retrograde screw fixation of anterior column acetabular fractures: a biomechanical in vitro study. Eur J Trauma Emerg Surg 2019; 47:1307-1312. [PMID: 31664465 DOI: 10.1007/s00068-019-01255-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND To compare the mechanical strength of antegrade versus retrograde lag screw fixation of anterior column acetabular fractures. METHODS Standardised anterior column fractures were created in synthetic pelvis models and stabilised by either antegrade (ANTE, n = 4) or retrograde (RETRO, n = 4) anterior column screw fixation. In a validated setup, a cyclic loading protocol was applied with increasing axial force (750 cycles, 250-750 N) followed by load to failure. Construct survival, energy absorbed, construct stiffness, and load to failure were assessed. Descriptive and opto-metric methods were used to describe the mode of failure. RESULTS All constructs failed with loads below 1500 N. With regard to energy absorbed until failure, the ANTE group resisted to 3.763 × 105 N*cycles (range 3.760 × 105-3.763 × 105) and the RETRO group to 3.762 × 105 N*cycles (range 3.761 × 105-3.765 × 105; p = 1.0). The load to failure was 1254 N (range 977-1299) in the ANTE group and 1234 N (range 1087-1456) in the RETRO group (p = 1.0). Construct stiffness with 250 N was not different between the two groups (ANTE 192 N/mm vs. RETRO 215 N/mm, p = 0.486). In all samples, the mode of failure was a transiliac fracture with screw breakout due to rotation of the pubic fragment around the axis of the screw with a range of rotational motion [ROM] during cyclic testing of 0.96° in one ANTE sample and 0.82° in one RETRO sample for 750 N, and ROM at failure of 2.53° in one ANTE sample and 2.23° in one RETRO sample. There was some plastic deformation of the screws in all cases but no breakage. CONCLUSIONS In this in vitro mechanical study, antegrade screw fixation of an anterior column acetabular fracture was not different in construct survival, load to failure, stiffness, and mode of failure when compared to retrograde screw fixation.
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Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Dag Wulsten
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Satish Babu
- Trauma and Orthopaedic Department, Frimley Park Hospital, Camberley, UK
| | - Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Carlotta Pari
- Orthopaedic, and Trauma Department, Santa Maria Delle Croci Hospital, Ravenna, Italy
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Yang Y, Zou C, Fang Y. A study on fracture lines of the quadrilateral plate based on fracture mapping. J Orthop Surg Res 2019; 14:310. [PMID: 31514742 PMCID: PMC6739924 DOI: 10.1186/s13018-019-1318-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/15/2019] [Indexed: 02/05/2023] Open
Abstract
Background Quadrilateral plate fractures are a challenging group of acetabular fractures to manage. However, there is little literature that describes the fracture lines of the quadrilateral plate. The aim of this study was to explore the fracture lines of the quadrilateral plate and relevant clinical significance. Methods CT data from a series of acetabular fractures were retrospectively analyzed. According to the X-ray, CT, and operative records of the patients, Judet-Letournel classification was carried out for acetabular fractures involving quadrilateral plate. Then, the fracture maps of different types of acetabular fractures in the quadrilateral plate were drawn. To facilitate the characterization of fracture maps, we defined six basic fracture lines. Results The fracture lines of the three types of acetabular fractures (double-column fracture, T-type fracture, and anterior column with posterior hemitransverse fracture) mainly included upper transverse lines and upper oblique lines. Although the fracture lines of posterior wall fracture and anterior column fracture were mainly upper transverse lines, the fracture lines of the former were in a low position. The fracture lines of transverse fracture and transverse with posterior wall fracture were similar, both of which were mainly upper oblique lines. The fracture lines of posterior column fractures mainly included posterior vertical lines. Conclusions The fracture lines of different types of acetabular fractures have certain regularity respectively. Observation of the fracture lines of the quadrilateral plate based on fracture mapping can help orthopedic surgeons to enhance the understanding of the Judet-Letournel classification, which may have some significant guidance on the choice of operation approach and the design of internal fixation devices.
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Affiliation(s)
- Yun Yang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Chang Zou
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yue Fang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Precontoured Quadrilateral Surface Acetabular Plate Fixation Demonstrates Increased Stability When Compared With Pelvic Reconstruction Plates: A Biomechanical Study. J Orthop Trauma 2019; 33:e325-e330. [PMID: 31436712 DOI: 10.1097/bot.0000000000001496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the stability of 3 fixation strategies for a transverse acetabular fracture: a reconstruction plate with anterior and posterior column screws (group A); an infrapectineal precontoured quadrilateral surface buttress (iPQSB) plate alone (group B); and an anterior column lag-screw and iPQSB plate (group C). METHODS A transverse acetabular fracture was created in 18 synthetic hemipelvises. Six were fixed by each of the 3 methods described. Specimens underwent cyclic axial compressive loading to 1700N for 42,000 cycles while anterior and posterior column displacements were measured, followed 4800N for 50 cycles. Displacement and stiffness data were analyzed with analysis of variance and Tukey HSD. A Cox proportional hazards regression model was used to determine survival rate. P values < 0.05 were considered significant. RESULTS Group C had significantly less posterior column displacement (0.16 ± 0.06 mm) compared with group B (0.38 ± 0.37 mm, P < 0.0001) and group A (0.38 ± 0.37 mm, P < 0.0001). In addition, group A had significantly more anterior column displacement (0.28 ± 0.11 mm) than group B (0.22 ± 0.14 mm, P = 0.0310) and group C (0.18 ± 0.09 mm, P = 0.0001). Group C was 10.5% stiffer than group A (P = 0.0037). Group B had a 7.27x greater rate of failure than group C (95% confidence interval, 1.6-33.2). DISCUSSION AND CONCLUSION Under anatomical loading, iPQSB plates with anterior column lag-screw fixation demonstrate increased stability in a synthetic bone transverse acetabular fracture model. Based on our data, we support additional evaluation of early weight-bearing after transverse acetabular fracture fixation in patients with healthy bone when an anterior column screw-iPQSB plate construct is used.
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He L, Sun Y, Hou Z, Zhang Q, Hu Y, Bai X, Yi C. The "safe zone" for infrapectineal plate-screw fixation of quadrilateral plate fractures: An anatomical study and retrospective clinical evaluation. Medicine (Baltimore) 2019; 98:e15357. [PMID: 31083163 PMCID: PMC6531153 DOI: 10.1097/md.0000000000015357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/22/2019] [Accepted: 03/29/2019] [Indexed: 11/26/2022] Open
Abstract
Extra-articular screw placement in the true pelvis for fixing quadrilateral plate fractures remains challenging. We aimed to define the "safe zone" on the quadrilateral surface to facilitate safe plate-screw placement.Twenty cadaveric hemipelves were sectioned and assembled to define the projection of the acetabular boundary on the quadrilateral surface. Three lines (X, Y, and Z) were drawn tangent to the projection, with X parallel to the iliopectineal line, Y perpendicular to the iliopectineal line, and Z parallel to the posterior border of the ischial body. Then, the distances between X and the iliopectineal line (D1), Y and the sacroiliac joint (D2), and Z and the posterior border of the ischium (D3) could be used to determine a "safe zone" on the quadrilateral surface for screw insertion. We included 15 patients whose conditions satisfied the definition of a comminuted quadrilateral plate fracture and applied two-ended buttress plates for treatment in accordance with this "safe zone."The average D1 was 50.0 mm, the average D2 was 30.6 mm, and the average D3 was 12.4 mm. For all 15 patients with comminuted quadrilateral fracture who were treated, no intraoperative or postoperative screw penetration of the acetabulum was identified, and no loss of reduction was observed during an average follow up of 17.7 months.The "safe zone" established in this study simplifies extraarticular screw placement for managing quadrilateral plate fractures in the true pelvis. As a result, two-ended buttress plate fixation in the true pelvis becomes safe, therefore, treatment with two-ended buttress plates may represent a viable alternative to single-ended elastic fixation in the management of comminuted quadrilateral fractures.
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Affiliation(s)
- Li He
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
| | - Yun Sun
- Department of Orthopaedic Surgery, Jiujiang University Hospital, Jiujiang University Clinical Medical College, Xun Yang East Road 57, Jiujiang
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Zi Qiang Avenue 139, Shijiazhuang, China
| | - Qian Zhang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
| | - Yinghua Hu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
| | - Xiangjun Bai
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan
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Zhang R, Yin Y, Li S, Jin L, Guo J, Hou Z, Zhang Y. Fixation of Displaced Acetabular Fractures With an Anatomic Quadrilateral Surface Plate Through the Stoppa Approach. Orthopedics 2019; 42:e180-e186. [PMID: 30602047 DOI: 10.3928/01477447-20181227-03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/09/2018] [Indexed: 02/03/2023]
Abstract
Satisfactory fixation for displaced acetabular fractures involving the quadrilateral surface remains difficult to obtain with conventional reconstruction plates. To achieve minimally invasive management of fractures of the quadrilateral surface, the authors designed a type of anatomic quadrilateral surface plate (AQSP). A retrospective study to assess the therapeutic results of the AQSP was performed at their institution. A total of 26 patients with quadrilateral surface fractures fixed with an AQSP through the Stoppa approach from February 2014 to February 2015 were included in this study. There were 16 men and 10 women with a mean age of 37.5 years. The patients were followed for a mean of 28.81 months (range, 24-36 months). The mean operative time was 98.85±16.08 minutes, and the mean intraoperative blood loss was 353.85±124.84 mL. Postoperative radiographs and computed tomography scans showed that anatomic and good reductions were obtained in 88.46% (23 patients) and 11.54% (3 patients) of the patients, respectively. Screw loosening was not observed. All of the fractures healed well at a mean of 3.54 months. Two cases of obturator nerve injury and 1 case of corona mortis rupture were observed. However, permanent complications were not observed. The mean Merle d'Aubigné score at final follow-up was 16.38±1.33 points. The authors conclude that satisfactory fixation with the AQSP system can be achieved through the Stoppa approach. [Orthopedics. 2019; 42(2):e180-e186.].
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YÜCENS M, ALEMDAROĞLU KB, ÖZMERİÇ A, İLTAR S, YILDIRIM AÖ, H. AYDOĞAN N. A comparative biomechanical analysis of suprapectineal and infrapectineal fixation on acetabular anterior column fracture by finite element modeling. Turk J Med Sci 2019; 49:442-448. [PMID: 30761832 PMCID: PMC7350873 DOI: 10.3906/sag-1806-72] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background/aim The aim of this study is to compare the stability and implant stresses of suprapectineal plate with infrapectineal plate in three subconfigurations of the screw types. Materials and methods The stabilities of different fixation methods were compared by finite element analysis on six models. Three infrapectineal and three suprapectineal models each with locked, unlocked, or combined screws were employed. Three-dimensional finite element stress analysis was performed by using isotropic materials with a load of 2.3 kN applied at standing positions. Motion at the fracture line was measured on four different points located on the pubic and iliac sides of the fracture line. Results Infrapectineal plate fixation with unlocked screws was found to be the most stable fixation method with 0.006 mm displacement of fragments in all axes at standing positions. The suprapectineal unlocked method was found to be the most unstable in standing positions with maximum displacement values of 0.46 mm vertical shear movement in the x-axis, –0.14 mm displacement in the y-axis, and –0.33 mm lateral shear in the z-axis. Conclusion The infrapectineal unlocked plate supplies the most stable fixation with the least implant stress, contrary to the suprapectineal unlocked plate, which has the lowest stability and highest implant stresses.
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Affiliation(s)
- Mehmet YÜCENS
- Department of Orthopedics, Faculty of Medicine, Pamukkale University, DenizliTurkey
- * To whom correspondence should be addressed. E-mail:
| | | | - Ahmet ÖZMERİÇ
- Department of Orthopedics, Ankara Training and Research Hospital, AnkaraTurkey
| | - Serkan İLTAR
- Department of Orthopedics, Ankara Training and Research Hospital, AnkaraTurkey
| | | | - Nevres H. AYDOĞAN
- Department of Orthopedics, Faculty of Medicine, Muğla University, MuğlaTurkey
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Busuttil T, Teuben M, Pfeifer R, Cinelli P, Pape HC, Osterhoff G. Screw fixation of ACPHT acetabular fractures offers sufficient biomechanical stability when compared to standard buttress plate fixation. BMC Musculoskelet Disord 2019; 20:39. [PMID: 30678661 PMCID: PMC6346571 DOI: 10.1186/s12891-019-2422-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Geriatric acetabular fractures require fixation with sufficient primary stability to allow for immediate full-weight bearing. Minimally-invasive procedures would be desirable in order to keep perioperative morbidity low. The purpose of this study was to compare the biomechanical strength of lag screw-only fixation of anterior column posterior hemi-transverse (ACPHT) acetabular fractures to standard anatomical plate fixation. METHODS Standardized ACPHT fractures were created in fourth generation synthetic pelvis models and stabilized by either an anatomical buttress plate (n = 4) or by a screw-only construct (n = 4). In a validated setup, a cyclic loading protocol was applied with increasing axial force (3200 cycles, 175 N to 2250 N). Construct survival, acetabular fracture motion, and mode of failure were assessed. RESULTS The median number of cycles needed until failure of the construct occurred was 2304 cycles (range, 2020 to 2675) in the plate fixation group and 3200 cycles (range, 3101 to 3200) for the screw fixation constructs (p = .003). With regard to energy absorbed until failure, the plate fixation group resisted to 1.57 × 106 N*cycles (range, 1.21 × 106 to 2.14 × 106) and the screw fixation group to 3.17 × 106 N*cycles (range, 2.92 × 106 to 3.17 × 106; p = .001). All plate fixation specimens failed with a break-out of the posterior-column screw in the quadrilateral wing of the anatomical plate within a maximum load of 1750 N while the screw fixation constructs all survived loading of at least 2100 N. Acetabular fracture gap motion, acetabular rim angle, and medial femoral head subluxation as measures of fracture displacement were all not different between the two groups (p > 0.1). CONCLUSIONS In this in vitro biomechanical study, screw-only fixation of an ACPHT acetabular fracture resulted in at least as good construct survival as seen for standard buttress plate fixation. Both methods resisted sufficiently to forces that would be expected under physiologic conditions.
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Affiliation(s)
- Tatjana Busuttil
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Michel Teuben
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Paolo Cinelli
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | | | - Georg Osterhoff
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland. .,Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
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Tanoğlu O, Alemdaroğlu KB, İltar S, Özmeriç A, Demir T, Erbay FK. Biomechanical comparison of three different fixation techniques for anterior column posterior hemitransverse acetabular fractures using anterior intrapelvic approach. Injury 2018; 49:1513-1519. [PMID: 29934096 DOI: 10.1016/j.injury.2018.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/01/2018] [Accepted: 06/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to biomechanically compare three different fixation methods for the fixation of anterior column posterior hemitransverse type acetabular fracture (ACPHT). METHODS ACPHT fracture models were created on twenty-four foam cortical shell artificial hemipelvis models. Three fixation methods were assessed - Group 1: posterior column lag screws over a suprapectineal plate; Group 2: Posterior column lag screws over a suprapectineal plate and an infrapectineal plate; Group 3: A suprapectineal plate and a vertical infrapectineal plate. Stiffness and displacement amounts of fixation methods under dynamic and static axial loading conditions were measured. RESULTS In the dynamic and static tests, Group 3 showed the less stable fixation compared to Group 2. There was no statistically significant difference between the stiffness values of the fixation groups. In the static tests, there was no statistically significant difference between Group 1 and 2, although less displacements were obtained in Group 2. CONCLUSIONS A combination of posterior lag screws over a suprapectineal plate and an infrapectineal plate supporting the pelvic brim along both sides of the linea terminalis resulted in a better fixation construct than a suprapectineal plate accompanying with a vertical infrapectineal plate provide better stability with less fracture displacement.
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Affiliation(s)
- Oğuzhan Tanoğlu
- Erzincan University Mengücek Gazi Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.
| | | | - Serkan İltar
- SBU Ankara Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey
| | - Ahmet Özmeriç
- SBU Ankara Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey
| | - Teyfik Demir
- TOBB Economics and Technology University, Mechanical Engineering Department, Turkey
| | - Fatma Kübra Erbay
- TOBB Economics and Technology University, Micro-Nanotechnology Programme, Turkey
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May C, Egloff M, Butscher A, Keel MJB, Aebi T, Siebenrock KA, Bastian JD. Comparison of Fixation Techniques for Acetabular Fractures Involving the Anterior Column with Disruption of the Quadrilateral Plate: A Biomechanical Study. J Bone Joint Surg Am 2018; 100:1047-1054. [PMID: 29916932 DOI: 10.2106/jbjs.17.00295] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In elderly patients who have sustained an acetabular fracture involving disruption of the quadrilateral plate (QLP), postoperative loading of the joint beyond the level of partial weight-bearing can result in medial redisplacement of the QLP. The purpose of this biomechanical study was to compare the performances of 4 different fixation constructs intended to prevent medial redisplacement of the QLP. METHODS Anterior column posterior hemitransverse (ACPHT) fractures with disruption of the QLP were created on synthetic hemipelves (fourth-generation Sawbones models) and subsequently stabilized with (1) a 12-hole plate bridging the QLP (Group 1), (2) the plate with added periarticular screws along the QLP (Group 2), (3) the plate combined with an infrapectineal buttress plate (Group 3), or (4) the plate with the added periarticular screws as well as the buttress plate (Group 4). The point of load application on the acetabulum was defined to be the same as the point of application of maximum vertical hip contact force during normal walking. Loads were applied to simulate either partial weight-bearing (20 cycles, from 35 to 350 N) or inadvertent supraphysiologic loads (linearly increasing loads until the onset of failure, defined as fragment displacement of >3 mm). A universal testing machine was synchronized with a digital image correlation system to optically track redisplacement at the QLP. The level of significance was set at p < 0.05. RESULTS During experimental simulation of partial weight-bearing, maximum fracture step openings never exceeded 2 mm. During simulation of inadvertent supraphysiologic load, the median load to failure was higher (p < 0.05) in Group 2 (962 N; range, 798 to 1,000 N) and Group 4 (985 N; range, 887 to 1,000 N) compared with Group 1 (445 N; range, 377 to 583 N) and Group 3 (671 N; range, 447 to 720 N). CONCLUSIONS All 4 fixation constructs performed in an acceptable manner on testing with simulated partial weight-bearing. Only additional periarticular screws along the QLP increased the fixation strength. CLINICAL RELEVANCE Redisplacement of the QLP resulting in an incongruency of the hip joint has been associated with poor long-term outcomes. Within the constraints of this study, periarticular long screws were superior to infrapectineal buttress plates in preventing medial redisplacement of the QLP.
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Affiliation(s)
| | - Mike Egloff
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | | | | | - This Aebi
- DePuy Synthes Trauma, Zuchwil, Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | - Johannes Dominik Bastian
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
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Zhou X, Zhang Q, Song W, Zhou D, He Y. Clinical significance of three-dimensional skeleton-arterial model in the management of delayed reconstruction of acetabular fractures. BMC Surg 2018; 18:30. [PMID: 29843704 PMCID: PMC5975535 DOI: 10.1186/s12893-018-0362-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delayed reconstruction of acetabular fractures remains a challenging task for orthopedists because of malunion, fracture line absorption, and scar formation. Accurate osteotomy, interfragmentary release, and proper adaptation of plates are keys to successful surgery. Prevention of superior gluteal artery (SGA) injury induced by cleaning of the osteotylus and reduction of the sciatic notch is also important. Therefore, sufficient preoperative planning is essential. However, traditional planning methods do not readily provide direct visual and tactile feedback to surgeons. Rapid prototyping (RP) models have provided new opportunities in the preoperative planning of delayed reconstruction of acetabular fractures. We hypothesized that a three-dimensional (3D) skeleton-arterial model would improve both preoperative planning in the management of fractures and arteries and intraoperative assistance during delayed reconstruction of complex acetabular fractures. METHODS Eight patients were enrolled in this study. Data on the skeleton and arteries were obtained from computed tomography and angiography scans and used to produce RP models. Preoperative surgical planning and intraoperative assistance were performed using these models as references. RESULTS All 3D skeleton-arterial models were extremely accurate. Reduction and fixation were performed programmatically and smoothly, and management of the SGA was reliably executed according to a thorough preoperative plan. The mean surgical time and intraoperative blood loss were 224.4 min and 1250 ml, respectively. Among the eight patients, four underwent anatomic reduction and five had excellent functional outcomes at the final follow-up. No significant complications occurred. CONCLUSIONS This 3D skeleton-arterial model is helpful for orthopedists in preoperative planning and intraoperative assistance.
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Affiliation(s)
- Xi Zhou
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Beijing, China
| | - Wenhao Song
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Ji'nan, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Ji'nan, Shandong, China.
| | - Yu He
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China.
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Dotivala S, Coomber R, Chowdhry M, Carrothers AD. Dual mobility total hip dislocation-femoral stem loosening while attempting closed reduction: a cautionary note. BMJ Case Rep 2018; 2018:bcr-2017-222408. [PMID: 29367367 DOI: 10.1136/bcr-2017-222408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 77-year-old man sustained an acetabular fracture after falling from a staircase and landing on his right side. He fractured the anterior column of his acetabulum and the quadrilateral plate. He underwent a single-stage open reduction and internal fixation of the fracture combined with a dual mobility total hip arthroplasty (THA). He sustained a traumatic hip dislocation 1 month postoperatively. Closed reduction was attempted at another hospital, and the femoral stem was pulled out. We believe this was caused by the polyliner being hitched either to the acetabular cup or in the soft tissues around the ilium. We present this case to caution orthopaedic surgeons that dual mobility THA dislocations are difficult to diagnose as the polyliner is not clearly seen on X-rays, and reduction attempts may lead to worsening of an already difficult situation.
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Affiliation(s)
- Sharukh Dotivala
- Trauma & Orthopaedics, Addenbrookes Hospital, Cambridge, Cambridgeshire, UK
| | - Ross Coomber
- Trauma & Orthopaedics, Addenbrookes Hospital, Cambridge, Cambridgeshire, UK
| | - Majid Chowdhry
- Trauma & Orthopaedics, Addenbrookes Hospital, Cambridge, Cambridgeshire, UK
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