1
|
Wang W, Cai X, Liu X, Wang G, Kang H, Qian S. Special contoured pelvic brim reconstruction titanium plate combined with trans-plate buttress screws (quadrilateral screws) for acetabular fractures with quadrilateral plate involvement through the anterior ilioinguinal approach. Front Surg 2024; 11:1438036. [PMID: 39328841 PMCID: PMC11424611 DOI: 10.3389/fsurg.2024.1438036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
Background Managing complicated acetabular fractures involving the quadrilateral plate (QLP) can be challenging for surgeons, especially when complicated by comminution and osteoporosis. Traditional implants do not provide sufficient fixed strength or a proper match. The new-type pre-contoured infrapectineal buttress plates may have drawbacks, such as inaccurate fitting on the medial surface of QLP and an inability to apply reversed compression force to resist medial displacement of femoral head. Therefore, the primary purpose of this study is to introduce a novel technique that utilizes a special contoured pelvic brim reconstruction titanium plate combined with quadrilateral screws to reduce and stabilize acetabular fractures involving the QLP through the ilioinguinal approach. Additionally, the secondary purpose is to evaluate both clinical effectiveness and radiological outcomes of this technique for QLP fractures. Methods We conducted a retrospective analysis of prospectively collected data from 48 patients (31 males and 17 females) who suffered from acute displaced fractures of the QLP and were treated between January 2012 and December 2019 using a special contoured plate combined with quadrilateral screws. The patients' mean age was 47.56 ± 11.31 years (range: 19-73 years). Fracture patterns included 20 both-column fractures, 12 anterior column and posterior hemitransverse fractures, eight T-type fractures, five transverse fractures and three anterior column fractures with the QLP affected, all of which had femoral head protrusion. Immediate postoperative reduction quality was evaluated according to Matta's criteria. Final clinical functions were assessed during follow-up using the modified Merle d'Aubigné and Harris Hip scores (HHS). Results The patients were followed up for an average of 48.36 ± 12.94 months (ranging from 24 to 84 months). The mean operative time was 246.08 ± 54.30 min (ranging from 178 to 397 min), and the average blood loss was 715.16 ± 263.84 ml (ranging from 400 to 2000ml). The radiological grading at postoperative stage showed anatomical reduction in 30 patients (62.50%), satisfactory reduction in 14 patients (29.17%), and poor reduction in four patients (8.33%). At the final follow-up, no re-protrusion of the femoral head was observed. In terms of functional outcome, the mean modified Merle d'Aubigné-Postel score was excellent in 26 patients (54.17%), good in 17 patients (35.42%), fair in four patients (8.33%), and poor in one patient (2.08%). The HHS was excellent in 23 patients (47.92%), good in 20 patients (41.67%), fair in four patients (8.33%), and poor in one patient (2.08%). The average HHS was 87.38 ± 7.86 (ranging from 52 to 98). Postoperative complications included lateral femoral cutaneous nerve injury in two patients, delayed wound healing and subsequent development of an inguinal hernia in one patient. Late complications were observed in two patients, with one case of heterotopic ossification and another case of post-traumatic osteoarthritis underwent hip arthroplasty within two years after surgery. Conclusion Our results indicate that employing the contoured plate specifically designed for QLP injuries, in conjunction with quadrilateral screws through the ilioinguinal approach, can lead to positive outcomes in the treatment of displaced acetabular fractures involving the QLP. This straightforward and efficient technique offers a viable option for surgeons who are managing complex acetabular fractures.
Collapse
Affiliation(s)
- Wei Wang
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
- Department of Orthopedic Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine (Affiliated Hospital of Hubei University of Traditional Chinese Medicine), Wuhan, China
| | - Xianhua Cai
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
- Department of Orthopedic Surgery, South China Hospital of Shenzhen University, Shenzhen, China
| | - Ximing Liu
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Guodong Wang
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Hui Kang
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| | - Shenglong Qian
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, Wuhan, China
| |
Collapse
|
2
|
Menger MM, Herath SC, Ellmerer AE, Trulson A, Hoßfeld M, Leis A, Ollig A, Histing T, Küper MA, Audretsch CK. Different coupling mechanisms for a novel modular plate in acetabular fractures-a comparison using a laparoscopic model. Front Surg 2024; 11:1357581. [PMID: 38919977 PMCID: PMC11196767 DOI: 10.3389/fsurg.2024.1357581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/14/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Acetabular fractures are among the most challenging injuries in traumatology. The complex anatomy usually requires extensive surgical approaches baring the risk for iatrogenic damage to surrounding neurovascular structures. As a viable alternative, minimally invasive endoscopic techniques have emerged during the recent years. This paper reports on the feasibility of different coupling mechanisms for a novel suprapectineal plate especially designed for minimally invasive acetabular surgery. Methods A total number of 34 participants contributed to the present study, who differed in their arthroscopic and surgical experience. A laparoscopic model was used to compare four different coupling mechanisms by the number of failed attempts, the time required for plate fixation, the influence of surgical experience as well as the learning success for each individual coupling mechanism. Moreover, the feasibility of each mechanism was evaluated by a questionnaire. Results The results demonstrate that plates employing grooved and pressure-sliding coupling mechanisms exhibit fewer failed attempts and reduce trial times, especially in contrast to sole sliding mechanisms. Furthermore, our study revealed that proficiency in endoscopic procedures significantly influenced the outcome. Notably, the subjective evaluation of the participants show that the pressure base and pressure-slide base plate designs are the most supportive and feasible designs. Conclusions In summary, the present study evaluates for the first-time different plate and coupling designs for minimal-invasive surgery, indicating a superior feasibility for plates with a grooved and pressure-sliding mechanism.
Collapse
Affiliation(s)
- Maximilian M. Menger
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Steven C. Herath
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Andreas E. Ellmerer
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Trulson
- Department for Traumatology, Orthopedics and Surgery, BG Trauma Center, Murnau am Staffelsee, Germany
| | - Max Hoßfeld
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Artur Leis
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Annika Ollig
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Markus A. Küper
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Christof K. Audretsch
- Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
| |
Collapse
|
3
|
Ahmadi MA, Moein SA, Fereidooni R, Ayatizadeh SH. Use of calcaneal locking plate in surgical treatment of quadrilateral plate fractures of the acetabulum. Musculoskelet Surg 2024:10.1007/s12306-024-00830-4. [PMID: 38814429 DOI: 10.1007/s12306-024-00830-4] [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: 05/05/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Specialized devices for fixation of the acetabulum quadrilateral plate (QP) fractures may not be readily available in resource-constrained settings. In this article, we aim to explore the use of a 3.5-mm locking calcaneal plate in fixation of QP fractures. METHODS Twenty-eight patients with QP fractures underwent surgery using the modified Stoppa approach. Follow-up at 12 months assessed fracture healing and functional outcomes using the Majeed pelvic outcome score. Descriptive statistics summarized patient demographics and fracture characteristics. Analysis of variance (ANOVA) and exact logistic regression explored associations between factors (age, AO/OTA classification, gender, and time to surgery) and Majeed scores. RESULTS The mean age of patients was 42.71 years, with the majority being male (64.29%). All patients achieved bony union. Post-traumatic arthritis developed in three patients, while two patients experienced post-operative fracture redisplacement. Evaluation using the Majeed pelvic outcome score revealed generally favorable outcomes, with 32.14% achieving excellent, 39.29% good, 21.43% fair, and 7.14% poor outcome. Only an older age was associated with a worse outcome score (excellent/good versus fair/poor, odds ratio: 0.87, 95% confidence interval: 0.77, 0.96). CONCLUSION Surgical management of quadrilateral plate fractures using 3.5-mm locking calcaneal plates demonstrates promising outcomes, particularly in resource-constrained settings, where specialized devices may be lacking.
Collapse
Affiliation(s)
- Mohammad Amin Ahmadi
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Arman Moein
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Reza Fereidooni
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Hamidreza Ayatizadeh
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
4
|
Chongshuai B, Xuhang Y, Li H, Qingshuang Y, Lin C, Jun A. Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: an anatomical-morphological study. BMC Musculoskelet Disord 2024; 25:417. [PMID: 38807120 PMCID: PMC11135013 DOI: 10.1186/s12891-024-07522-x] [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: 02/27/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to develop anatomical plates that align with the characteristics of the pelvis in the Chinese population. METHODS Pelvic computed tomography (CT) data from 102 adult patients were collected at the Affiliated Hospital of Zunyi Medical University. This group included 51 males and 51 females, aged between 20 and 60 years. Using Mimics software (version 21.0), a three-dimensional model of each pelvic data point was reconstructed. The fixation path for the combined reset anatomical steel plate was drawn, where the curves on the fixation path were approximated as arcs. The radius of curvature and length of these curves were measured, and an anatomical steel plate was designed to best fit the pelvic structure. RESULTS The combined anatomical reduction plate fixation system for quadrilateral acetabular fractures using a posterior approach consisted of two parts: a locking plate and a reduction plate. The posterior wall region (r2), ischial region (r3), quadrilateral region (r4), and bending region (r5), and the total length of the reduction plate were significantly smaller in females (P < 0.05). Similarly, the posterior wall region (R3), distal posterior wall region (R4), and the total length of the locking plate were significantly smaller in females (P < 0.05). Additionally, the anterior superior iliac spine side (r1) and the total length of the T-shaped auxiliary plate were significantly smaller in females (P < 0.05). The bending angle (< A) was also significantly smaller in females (P < 0.05). CONCLUSIONS The pelvic surface structure is irregular and varies greatly among individuals.Compared to the traditional steel plate, The combined reduction anatomical plate designed in this study demonstrated high precision and improved conformity to the anatomical structure of the pelvis.
Collapse
Affiliation(s)
- Bao Chongshuai
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Yan Xuhang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - He Li
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Yao Qingshuang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Chen Lin
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
| | - Ao Jun
- Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Jo WL, Chung YG, Shin SH, Lim JH, Kim MS, Yoon DK. Structural analysis of customized 3D printed plate for pelvic bone by comparison with conventional plate based on bending process. Sci Rep 2023; 13:10542. [PMID: 37386116 PMCID: PMC10310805 DOI: 10.1038/s41598-023-37433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
Pelvic bone fracture is highly complex, and its anatomical reduction is difficult. Therefore, patient-specific customized plates have been developed using three-dimensional (3D) printing technology and are being increasingly used. In this study, the reduction status in five representative pelvic fracture models was compared between two groups: the 3D printing plate (3DP) group using a patient-specific 3D printed plate after virtual reduction and the conventional plate (CP) group using a conventional plate by manual bending. The 3DP and CP groups included 10 and 5 cases, respectively. The fractured models were reduced virtually and their non-locking metal plates were customized using 3D printing. The process of contouring the conventional plates to fit the contact surface of the bone with the bending tool was conducted by an experienced pelvic bone trauma surgeon. The reduction and fixation achieved using the two different plate groups was compared, and the significance of differences in the results was analyzed using paired t-tests, after verifying the normality of data distribution. The vertex distances between the surface of the bone and the contact surface of the plate were significantly lower in the 3DP group than in the CP group (0.407 ± 0.342 and 2.195 ± 1.643, respectively, P = 0.008). Length and angular variations, which are measurements of the reduction state, were also lower in the 3DP group than in the CP group (length variation: 3.211 ± 2.497 and 5.493 ± 3.609, respectively, P = 0.051; angular variation: 2.958 ± 1.977 and 4.352 ± 1.947, respectively, P = 0.037). The customized 3D printed plate in the virtual reduction model provided a highly accurate reduction of pelvic bone fractures, suggesting that the customized 3D printed plate may help ensure easy and accurate reduction.
Collapse
Affiliation(s)
- Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Yang-Guk Chung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea.
| | - Seung-Han Shin
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Jae-Hak Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Moo-Sub Kim
- Industrial R&D Center, KAVILAB Co. Ltd., 06693, Seoul, Republic of Korea
| | - Do-Kun Yoon
- Industrial R&D Center, KAVILAB Co. Ltd., 06693, Seoul, Republic of Korea
| |
Collapse
|
7
|
Wang Z, Wang Z, Chen G, Gao M, Zhu R, Yang H. Clinical application of the anterior pelvic wall locking plate (APWLP) in acetabular fractures involving the quadrilateral surface. J Orthop Surg Res 2023; 18:76. [PMID: 36721227 PMCID: PMC9887884 DOI: 10.1186/s13018-022-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The management of acetabular quadrilateral surface fractures remains challenging for surgeons, and the treatment options for such fractures remain controversial. Quadrilateral surface surgery is a complex procedure involving combined approaches, and the quality of fracture reduction closely depends upon the surgical procedure, as well as the skill and experience of the surgeon. This study aimed to explore the clinical effects of applying an anterior pelvic wall locking plate (APWLP) through the lateral-rectus approach for treating acetabular fractures involving the quadrilateral surface. METHODS This retrospective analysis was comprised of 35 patients with acetabular fractures involving the quadrilateral surface who were treated with an APWLP in our hospital between June 2016 and December 2020. The patients included 25 males and ten females, with an average age of 52.45 years. All the patients were exposed through the lateral-rectus approach, six patients were exposed with an additional iliac fossa approach, and the fractures were fixed by combining an APWLP with a reconstruction plate. The Matta imaging standard was used to assess the quality of the fracture reduction, and the final follow-up clinical outcome was classified as excellent (18 points), good (15-17), fair (13-14), or poor (< 13) according to the modified Merle d'Aubigné-Postel scoring standard. RESULTS All patients successfully completed the operation, and there was no blood vessel or nerve injury during any of the operations. The average follow-up period was 26.11 months. The mean time of resuming full-weight-bearing activities was 12.88 weeks. Hip flexion and extension and internal and external rotation ranges of motion significantly increased over time. At the last follow-up, Matta's imaging evaluation showed that 24 cases were anatomically reduced, seven cases were satisfactory, and four cases were unsatisfactory. The satisfaction rate was 88.6% (31/35). According to the modified Merle d'Aubigné-Postel scoring standard, the hip function was excellent, good, fair, and poor in 23, 6, 4, and 2 cases, respectively. The excellent and good rates represented 82.9% of the total cases (29/35). CONCLUSION The findings suggest that the APWLP for acetabulum quadrilateral surface fracture achieve good to excellent clinical and radiological outcomes, and an APWLP may be a new treatment option for these fractures involving the quadrilateral surface.
Collapse
Affiliation(s)
- ZhiDong Wang
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - ZhenHeng Wang
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - GuangDong Chen
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - MaoFeng Gao
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - RuoFu Zhu
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| | - HuiLin Yang
- grid.429222.d0000 0004 1798 0228Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006 China
| |
Collapse
|
8
|
Soni A, Gupta R, Sen R. Acetabulum fractures in elderly patients: A review. Chin J Traumatol 2022; 25:331-335. [PMID: 35033421 PMCID: PMC9751531 DOI: 10.1016/j.cjtee.2021.12.004] [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: 12/21/2020] [Revised: 09/30/2021] [Accepted: 11/21/2021] [Indexed: 02/04/2023] Open
Abstract
Fractures of the acetabulum in elderly patients were often caused by low energy trauma. Fractures involving anterior column are more common and often associated with impaction and comminution. Osteoporosis further complicates the management. Percutaneous fracture fixation has low morbidity but it is a technically demanding procedure. Open reduction and fracture fixation is done with or without simultaneous total hip replacement. Delayed total hip replacement is considered in posttraumatic arthritis patients. Patients with minimal displaced fractures, associated both-column fractures with secondary congruence of joint and patients who are medically unfit for surgery can be managed non-operatively. Whatever be the method of management, these elderly patients should be mobilised as early as possible.
Collapse
Affiliation(s)
- Ashwani Soni
- Department of Orthopaedics, Government Medical College and Hospital, Sector-32, Chandigarh, 160030, India,Corresponding author.
| | - Ravi Gupta
- Department of Orthopaedics, Government Medical College and Hospital, Sector-32, Chandigarh, 160030, India
| | - Ramesh Sen
- Department of Orthopaedics, Max Super Speciality Hospital, Sahibzada Ajit Singh Nagar, Mohali, 160062, India
| |
Collapse
|
9
|
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.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Küper MA, Trulson A, Johannink J, Hirt B, Leis A, Hoßfeld M, Histing T, Herath SC, Amend B. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum: an anatomical feasibility study. J Robot Surg 2022; 16:1401-1407. [PMID: 35147842 DOI: 10.1007/s11701-022-01381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/29/2022] [Indexed: 11/26/2022]
Abstract
Pelvic ring injuries or acetabular fractures present a challenge to trauma surgeons. Recently, endoscopic dissection techniques for visualization of the anterior pelvic ring and acetabulum have been presented. Robotic-assisted surgical systems offer advantages in terms of improved visualization and easier instrument handling. The aim of this pilot anatomic study was to verify the feasibility of robotic-assisted plate osteosynthesis on the anterior pelvic ring and acetabulum. The experiment was performed on a human whole body specimen. The DaVinci system with standard instruments as used in RARP was used. After docking the system, the anterior pelvic ring was first prepared as previously described for the endoscopic techniques. This was followed by dissection of both acetabula analogous to pelvic lymphadenectomy as performed during RARP. After the dissection was performed along the pelvic brim up to the iliosacral joint, the complete anterior column of the acetabulum including quadrilateral surface and incisura ischiadica major could be visualized. Finally, robotic-assisted endoscopic plate osteosynthesis was performed on the symphysis and anterior acetabular column as previously described in the endoscopic techniques. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum is feasible with the available robotic-assisted systems. Due to the excellent freedom of movement of the robotic arms, combined with the magnifying 3D visualization of the system, highly accurate preparation of the situs in preparation for plate osteosynthesis can be performed. The question of reduction of dislocated fractures remains open and is the subject of further investigation. Compared with conventional laparoscopy, robotic-assisted preparation nevertheless appears to offer an advantage in view of the complexity of the operation.
Collapse
Affiliation(s)
- Markus A Küper
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
| | - Alexander Trulson
- Department for Traumatology, Orthopedics and Surgery, BG Trauma Center, Murnau am Staffelsee, Germany
| | - Jonas Johannink
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Artur Leis
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Max Hoßfeld
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Tina Histing
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Steven C Herath
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Bastian Amend
- Department for Urology, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
12
|
Huang G, Chen K, Wang Y, Guo X. Finite element analysis of the Union Plate in treating elderly acetabular fracture patients. J Orthop Surg Res 2022; 17:56. [PMID: 35093112 PMCID: PMC8800209 DOI: 10.1186/s13018-022-02951-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly acetabular fractures are one of the more difficult types of fractures to resolve. For patients at this age, the more common type of fracture is comminuted. How to better fix this type of fracture has always been an issue of concern. This study was performed to observe the mechanical properties of different internal fixation methods used in treating elderly acetabular fracture patients. METHODS A model of a comminuted acetabular fracture in osteoporosis was established, consisting of an anterior column-posterior hemitransverse fracture with disruption of the quadrilateral surface. Fixation of the acetabular fracture model using a reconstruction plate and Union Plates was simulated. For the different internal fixation methods, static and transient modal analyses were performed under different loads, with an action time of 0.21 s and an analysis time of 0.7 s. The stress of the model was observed in the static analysis, and the displacement of the nodes and the entire model in the U1 direction was observed in the transient modal analysis. RESULTS In the static analysis, the stress of the osteoporosis model, the suprapectineal pelvic reconstruction plate model, the infrapectineal quadrilateral surface buttress plate model, and the suprapectineal quadrilateral surface buttress plate model were 42.62 MPa, 37.49 MPa, 44.39 MPa, and 46.15 MPa, respectively. The stress was mainly distributed near the suprapubic branch. The corresponding displacement in the U1 direction was 0.1500 mm, 0.1020 mm, 0.0836 mm, and 0.0990 mm, respectively. In the transient modal analysis, there was a significant difference in displacement between the different models (P < 0.05). When different loads were applied with the same fixation method, there was no significant difference in model displacement (P > 0.05). CONCLUSION Static and transient modal analyses show that the infrapectineal quadrilateral surface buttress plate or the suprapectineal quadrilateral surface buttress plate has an advantage in maintaining the stability of fracture fragments when fixing comminuted acetabular fractures in elderly individuals. The infrapectineal quadrilateral surface buttress plate also presents better biomechanical results.
Collapse
Affiliation(s)
- Guixiong Huang
- Department of Orthopaedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Kaifang Chen
- Department of Orthopaedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Yulong Wang
- Department of Orthopaedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Xiaodong Guo
- Department of Orthopaedics, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|