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Chen X, Wu H, Cheng K, Liu X, Cai X. Inclined angles of acetabular quadrilateral plate: digital measurement and clinical application of the new anatomical concept. J Orthop Surg Res 2023; 18:723. [PMID: 37749606 PMCID: PMC10518972 DOI: 10.1186/s13018-023-04143-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/27/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Matta scoring standard is one of the most frequently used postoperative imaging evaluations for acetabular fracture reduction, but has obvious shortcomings. This study, for the first time, proposed the concept of inclined angles of acetabular quadrilateral plate. The purpose of this study was to investigate the normal range of the inclined angles in adults by digital measurement and explore the feasibility of using them to evaluate the reduction quality of acetabular quadrilateral fractures after surgery. METHODS Firstly, the pelvic CT three-dimensional reconstruction data of 40 healthy adults including 20 males and 20 females were collected. The normal range of the anterior, middle, and posterior inclined angles were measured via Mimics software. Secondly, a modified Matta criteria that combined the classic Matta criteria and evaluation criteria of the inclined angles was proposed. And we classified modified Matta criteria into three grades including excellent, good and poor. Finally, a total of 125 cases with quadrilateral plate fractures was included and the postoperative CT data were analyzed by using both the classic Matta criteria and our modified Matta criteria. Then, the accuracy and consistency of both criteria to evaluate postoperative hip function was investigated. RESULTS The average anterior inclined angle: male (97.11° ± 2.59°), female (90.63° ± 2.09°); middle inclined angle: male (105.57° ± 1.93°), female (100.64° ± 2.46°); and posterior inclined angle: male (112.62° ± 2.54), female (106.37° ± 2.53°). Whether in males or in females, the anterior, middle, and posterior inclined angles showed a progressively increasing trend. All the three inclined angles in males were all significantly larger than those in females (p < 0.05). Among 125 cases with quadrilateral plate fractures, 101 cases (80.8%) were graded as excellent, 18 cases (14.4%) as good, and 6 cases (4.8%) as poor according to the classic Matta criteria. While based on modified Matta criteria, there were excellent in 37 cases (29.6%), good in 76 cases (60.8%), and poor in 12 cases (9.6%). According to the Harris hip score system, the functional outcomes were excellent in 59 cases (47.2%), good in 26 cases (20.8%), fair in 24 cases (19.2%), and poor in 16 cases (12.8%). Our results showed that among the cases evaluated as excellent according to the classic Matta criteria and modified Matta criteria, the excellent-to-good rates of hip function were 70.3% and 78.4%, respectively. And among the cases evaluated as poor according to the modified Matta criteria, the fair-to-poor rate of hip function was 75%, while this value was 50% for classic Matta criteria. Both differences were statistically significant (p < 0.05). CONCLUSION Inclined angles of the quadrilateral plate could be used to assess the quality of fracture reduction and provide a basis for evaluating the rotational displacement of fracture blocks in the quadrilateral plate, which compensates the shortage of classic Matta criteria.
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Affiliation(s)
- Xiaofeng Chen
- Department of Orthopaedic Surgery, Yangxin People's Hospital, Yangxin, 435200, Hubei, China
| | - Haiyang Wu
- Department of Clinical Medicine, Graduate School of Tianjin Medical University, Tianjin, 301700, China.
| | - Kunming Cheng
- Department of Intensive Care Unit, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ximing Liu
- Department of Orthopaedic Surgery, General Hospital of Central Theater Command, Wuhan, 430064, Hubei, China
| | - Xianhua Cai
- Department of Orthopaedic Surgery, South China Hospital Affiliated to Shenzhen University, Shenzhen, 518111, Guangdong, China.
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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:S0020-1383(23)00389-3. [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] [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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Three-dimensional morphological analysis of quadrilateral plate fragments in associated both-column acetabular fractures. Skeletal Radiol 2022; 51:2175-2184. [PMID: 35503105 DOI: 10.1007/s00256-022-04068-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether the fracture morphology of quadrilateral plate (QP) fragments is associated with the anterior and posterior columns in associated both-column (ABC) fractures. MATERIALS AND METHODS Three-dimensional computed tomography data of 100 ABC fractures treated at our hospital from August 2016 to August 2019 were retrospectively analyzed using Mimics and 3-matic software. The distribution of fracture lines was described using the fracture mapping technique. RESULTS One fragment presented on the QP was confirmed in 88% of the patients. The QP fragments' fracture lines were divided into the anterior oblique (AO), superior posterior oblique (SPO), and mid-posterior oblique (MPO) lines, occurring in 100, 86, and 8 cases, respectively. AO lines were distributed along the arcuate line. SPO lines were continuations of the AO lines, which were distributed to the posterior column from the greater sciatic notch to the lesser sciatic notch. MPO lines were involved in the QP's central area. A simple fracture was found at the proximal AO and SPO lines in 80% and 86% of all displaced fractures, respectively. AO lines distal to the superior rim of the acetabula were confirmed to be comminuted fractures in 32% of all cases. CONCLUSIONS In ABC fractures, there was only one QP fragment in nearly 90% of all cases. The QP fractures were mainly present in the QP's peripheral area. More than 80% of the fracture patterns on the cephalic side of the QP were simple. The reduction and internal fixation of QP fractures in ABC fractures should be in the cephalic region.
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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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Adamczyk A, Grammatopoulos G, van Walraven C. Minimizing misclassification bias with a model to identify acetabular fractures using health administrative data: A cohort study. Medicine (Baltimore) 2021; 100:e28223. [PMID: 34967356 PMCID: PMC8718247 DOI: 10.1097/md.0000000000028223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023] Open
Abstract
Acetabular fractures (AFs) are relatively uncommon thereby limiting their study. Analyses using population-based health administrative data can return erroneous results if case identification is inaccurate ('misclassification bias'). This study measured the impact of an AF prediction model based exclusively on administrative data upon misclassification bias.We applied text analytical methods to all radiology reports over 11 years at a large, tertiary care teaching hospital to identify all AFs. Using clinically-based variable selection techniques, a logistic regression model was created.We identified 728 AFs in 438,098 hospitalizations (15.1 cases/10,000 admissions). The International Classification of Disease, 10th revision (ICD-10) code for AF (S32.4) missed almost half of cases and misclassified more than a quarter (sensitivity 51.2%, positive predictive value 73.0%). The AF model was very accurate (optimism adjusted R2 0.618, c-statistic 0.988, calibration slope 1.06). When model-based expected probabilities were used to determine AF status using bootstrap imputation methods, misclassification bias for AF prevalence and its association with other variables was much lower than with International Classification of Disease, 10th revision S32.4 (median [range] relative difference 1.0% [0%-9.0%] vs 18.0% [5.4%-75.0%]).Lone administrative database diagnostic codes are inadequate to create AF cohorts. The probability of AF can be accurately determined using health administrative data. This probability can be used in bootstrap imputation methods to importantly reduce misclassification bias.
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Affiliation(s)
- Andrew Adamczyk
- Department of Surgery, University of Ottawa, Ottawa Hospital Research Institute, Canada
| | - George Grammatopoulos
- Department of Surgery, University of Ottawa, Ottawa Hospital Research Institute, Canada
| | - Carl van Walraven
- Department of Medicine, University of Ottawa, Canada
- Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa Hospital Research Institute, ICES, Canada
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