Use of Spring Plates in Fixation of Comminuted Posterior Wall Acetabular Fractures

Biomechanical Comparison of Fixation Methods for Posterior Wall Fractures of the Acetabulum: Conventional Reconstruction Plate vs. Spring Plate vs. Variable Angle Locking Compression Plate

Background and Objectives: Acetabular fractures, though infrequent, present considerable challenges in treatment due to their association with high-energy trauma and poor prognoses. Posterior wall fractures, the most common type among them, typically have a more favorable prognosis compared to other types. Anatomical reduction and stable fixation of the posterior wall are crucial for optimal treatment outcomes. This study aimed to biomechanically compare three commonly used fixation methods for posterior wall fractures of the acetabulum-a conventional reconstruction plate, a spring plate, and a 2.7 mm variable angle locking compression plate (VA-LCP). Materials and Methods: The study utilized 6 fresh-frozen cadavers, yielding 12 hemipelvises free from prior trauma or surgery. Three fixation methods were compared using a simple acetabulum posterior wall fracture model. Fixation was performed by an orthopedic specialist, with prebending of plates to minimize errors. Hemipelvises were subjected to quasi-static and cyclic loading tests, measuring fracture gap, stiffness, and displacement under load. Results: It showed no significant differences in fracture gap among the three fixation methods under cyclic loading conditions simulating walking. However, the conventional reconstruction plate exhibited a greater stiffness compared to the spring and variable angle plates. Fatigue analysis revealed no significant differences among the plates, indicating a similar stability throughout cyclic loading. Despite differences in stiffness, all three fixation methods demonstrated adequate stability under loading conditions. Conclusions: While the conventional reconstruction plate demonstrated a superior stiffness, all three fixation methods provided sufficient stability under cyclic loading conditions similar to walking. This suggests that postoperative limitations are unlikely with any of the three methods, provided excessive activities are avoided. Furthermore, the variable angle plate-like the spring plate-offers an appropriate stability for fragment-specific fixation, supporting its use in surgical applications. These findings contribute to understanding the biomechanical performance of different fixation methods for acetabular fractures, facilitating improved surgical outcomes in challenging cases.

Modified one third tubular plate (spring plate) augmented with reconstruction plates for treatment of comminuted posterior wall acetabular fractures, Short to midterm outcomes of 24 patients

The most common form of acetabular fracture is believed to be the posterior wall; its incidence ranges from 25% to 47%. Managing such fractures has been difficult in the past and until recently. To obtain a favorable functional outcome, an accurate diagnosis and a well-executed treatment strategy are essential.

Objective

To evaluate the clinical and functional outcomes of employing a spring plate augmented by a traditional 3.5 mm reconstruction plate for the treatment of comminuted posterior wall acetabular fractures.

Patients and Methods

A prospective case series was performed on 24 patients with comminuted fractures of the posterior wall. After an average of 6 days, the patients underwent surgery. Eighteen patients were fixed with one spring plate, six patients were fixed with two spring plates, and all were reinforced with a 3.5-mm reconstruction plate. Each case was followed once every three months until the fracture healed and then regularly every six months thereafter.

Results

There were 21 men and 3 women. The average follow-up period was 14 months, and the median age was 34.5 years. The main reason for injuries was motor vehicle collisions. The mean operation time was 107.5 min. The clinical results were evaluated by the MAP and m HHS, and the means were 10.2 (5-12) and 86 (64-96), respectively. Only two patients developed avascular necrosis and were treated by total hip replacement, another three (12.5%) had mild arthritis.

Conclusion

Comminuted acetabulum posterior wall fractures can be stabilized with spring plates. It could be used in conjunction with the primary reconstruction plate as a viable alternative for stable and anatomical reduction. High patient satisfaction and good functional results make this approach effective.

Using calcaneal plates in fixation of comminuted posterior wall acetabular fractures with cranial or posterior extension: a prospective case series and novel technique

BACKGROUND

This study aims to evaluate the outcomes of using calcaneal plate in fixation of comminuted posterior wall (PW) acetabular fractures especially that have cranial (dome) or posterior extension (posterior column edge), and to evaluate its safety. To our knowledge, this is the first study that utilizes this off label implant technique in fixation of such fracture.

METHODS

Twenty-two patients enrolled in the study with a minimum follow up of one year. After reducing the PW fragments sequentially, calcaneal plate was applied, fixing its distal part at ischial tuberosity upper ends using 3 screws in a triangular fashion, while its proximal part and radial wings were firmly fixed along the acetabular rim together with the classic longitudinal anchorage. Any fixation failure or head subluxation was recorded.

RESULTS

Radiological outcome showed 18 cases scored as excellent, 2 were good, and 2 were poor. The functional outcome revealed 2 patients were excellent, 6 were very good and 14 were good. There was no loss of reduction or fixation failures throughout the follow up period.

CONCLUSION

Calcaneal plate may offer an alternative method of fixation of comminuted PW fractures with acceptable radiological and functional results. Our study result may encourage the comprehensibility and replicability of this practice, however randomized multicentered studies should be conducted to validate this assumption. This method provides valuable trick strategy, stable and soft-tissue-friendly fracture fixation where modern implantations may be unavailable or of high cost. Calcaneal plates show some fascinating features that allow using them outside their field being flexible with large footprint area for fracture buttressing beside numerous hole choices with diverse paths providing suitable fixation, articular stability and wide zone of coverage in PW comminuted fracture patterns with cranial or posterior extensions. The plate proximal triangular configuration together with distal triangular screw fixation gives a stiff rigid anchorage and buttressing similar to a metal mesh covering and fixing any fragment numbers up to dome level.

Novel implant design for comminuted posterior wall acetabular fractures

BACKGROUND

In recent years, the medical community has witnessed a notable increase in high-energy traumatic injuries, leading to a surge in complex fracture patterns that challenge existing treatment methodologies. Among these, the posterior approach to acetabular fractures stands out for offering direct visualization of the retro-acetabular surface, with current fixation methods relying on 3.5 mm low-profile reconstruction plates and various other implants. Despite the effectiveness of these methods, there is a burgeoning demand for a singular, adaptable implant that not only streamlines the surgical process but also optimizes patient outcomes.

METHODS

In an innovative approach to address this need, three-dimensional (3D) models of the posterior acetabular wall were meticulously crafted using AutoCAD® software. The chosen material for the implant was 316L surgical steel for its durability and strength. The design of the implant featured a low-profile mesh structure, which was instrumental in facilitating osteosynthesis. This design allowed for the placement of screws of varying lengths in multiple directions, ensuring the initial reconstruction of the joint in an anatomical position without hindering the placement of the definitive implant. The primary objective was to secure the fixation and stabilization of the fracture by specifically targeting the smaller bone fragments. A comparative analysis was then conducted between this novel plate and a conventional 316L surgical steel, seven-hole, 3.5 mm reconstruction plate through finite element analysis.

RESULTS

The comparative analysis unveiled that both plates demonstrated comparable deformation capacities, with no significant differences in load-bearing capabilities observed. This finding suggests that the innovative plate can match the performance of traditional plates used in such surgeries.

CONCLUSIONS

The finite element analysis revealed that the newly developed anatomical plate for posterior wall acetabular fractures meets the necessary physical and mechanical criteria for permanent implementation in patients with these fractures. This breakthrough represents a promising advancement that could simplify surgical procedures and potentially elevate patient outcomes.

LEVEL OF EVIDENCE II

This study is classified as a Level II, diagnostic study.

Outcomes of spring-locking plate fixation method using locking mesh plate/box plate for posterior wall fractures of the acetabulum: a retrospective single-centre study

INTRODUCTION

This retrospective study evaluated the outcomes of variable-angle locking compression plate, mesh plate, or footplate box fixation for posterior acetabular wall fractures.

PATIENTS AND METHODS

The study included nine patients with unstable posterior acetabular wall fractures who underwent internal fixation with the "spring-locking plate fixation method" between January 2015 and December 2019. Patient demographics, fracture classifications, surgical details, radiological and clinical evaluations, and complications were collected from electronic medical records. Statistical analyses were performed to assess the relationship between preoperative and postoperative dislocations.

RESULTS

The mean age of the patients was 46 years, and the majority were men (88.9%). Fracture types included posterior wall fractures and posterior column plus posterior wall fractures. The mean operative time was 246 min and the mean blood loss was 663 mL. The surgical approaches included the Kocher-Langenbeck, Ganz trochanteric flip, and transtrochanteric approaches. Variable-angle locking compression plate mesh plates and footplate box type implants were used for fixation. The mean preoperative dislocation was 23 mm, which was significantly reduced to 1 mm immediately post-operation and at the final observation. The bone fusion rate was 100% and radiological and clinical evaluations revealed favourable outcomes. Complications were minimal, with mild heterotopic ossification observed in four patients.

CONCLUSION

The spring-locking plate fixation method demonstrated satisfactory outcomes for the treatment of posterior acetabular wall fractures. This technique provides rigid fixation. Furthermore, the use of variable-angle locking screws minimizes the risk of intra-articular perforations. Despite limitations such as a small sample size and the absence of a control group, the results suggest that the spring-locking plate fixation method may be valuable in managing these fractures.

Spring Plates as a Valid Additional Fixation in Comminuted Posterior Wall Acetabular Fractures: A Retrospective Multicenter Study

BACKGROUND

The posterior wall fracture is the most frequent pattern of acetabular fractures. Many techniques of fixation have been described in the literature and involve plates, screws, or a combination of both. This study aims to investigate the clinical and radiological outcomes of spring plates in the treatment of comminuted posterior wall acetabular fractures. (2) Methods: A retrospective multicenter (four level I trauma centers) observational study was performed. Patients with a comminuted posterior wall acetabular fracture treated with a spring plate (DePuy Synthes, West Chester, PA) were included. Diagnosis was made according to the Judet and Letournel classification. Diagnosis was confirmed with plain radiographs in an antero-posterior view and Judet views, iliac and obturator oblique views, and thin-slice CT with multiplanar reconstructions. (3) Results: Forty-six patients (34 males and 12 females) with a mean age of 51.7 years (range 19-73) were included. The most common mechanism of injury was motor vehicle accident (34 cases). In all cases, spring plates were placed under an overlapping reconstruction plate. The mean follow-up was 33.4 months (range 24-48). The mean period without weight-bearing was 4.9 weeks (range 4-7), and full weight-bearing was allowed at an average of 8.2 weeks (range 7-11) after surgery. (4) Conclusions: According to the present data, spring plates can be considered a viable additional fixation of the posterior wall acetabular fractures.

Current indications for acute total hip arthroplasty in older patients with acetabular fracture: Evidence in 601 patients from 2002 to 2021

Purpose

Older patient population with acetabular fractures is increasing rapidly, requiring enhanced recovery. Acute total hip arthroplasty (THA) is a good option for these patients, and it is becoming increasing popular. However, acute THA has different indications in different studies. Therefore, a systematic review is needed to assess and comprehend the indications for acute THA in older patients.

Methods

A systematic literature review was conducted to identify a retrospective series or prospective studies in older patients (>60 years) with acetabular fractures. The search timeline was from database construction till December 2021; PubMed, Embase, and Cochrane Library databases were searched. Two trained professional reviewers independently read the full text of documents that met the inclusion criteria and extracted information on the specific methods used and indication information based on the research design.

Results

In total, there were 601 patients with acetabular fractures aged >60 years from 33 studies were obtained. Twenty-eight studies reported that THA was a feasible treatment option for acetabular fractures in geriatric patients with good outcome. The primary indications were dome impaction, irreducible articular comminution, femoral head injury, and pre-existing osteoarthritis or avascular necrosis. The most common patterns were anterior column and posterior hemitransverse, posterior wall, both columns, and T-type.

Conclusion

Acute THA is an effective treatment strategy for older patients with acetabular fractures and should be considered when the abovementioned indications are observed on preoperative images. (PROSPERO: CRD42022329555).

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis

Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes.

The survivorship and factors affecting the outcome of the use of spring plates in multifragmentary posterior wall acetabular fractures at a single academic institution

BACKGROUND

Multifragmentary posterior wall fractures are not uncommon after posterior hip fracture-dislocation. They can be elementary but are commonly associated with transverse acetabular fractures. Specific technical challenges are encountered when managing these fracture patterns. The loss of the posterior landmarks due to the associated comminution may render achieving an anatomical reduction and stable fixation difficult. The application of spring plates can provide a good buttress with multiple anchor points and creates a new cortex for the bridging plate.

PURPOSE OF THE STUDY

-To assess the outcome and survivorship of the use of spring plates for the fixation of multi-fragmentary posterior wall fractures. -To analyse the factors affecting the outcome of the fixation of these challenging injuries.

PATIENTS AND METHODS

We retrospectively reviewed all the patients who underwent posterior wall acetabular fixation using a spring plate between December 2009 and March 2020 at our institution. Forty-seven patients had a minimum follow-up of 1 year and were included in the study with a mean age of 36 ± 10 years (range:17-60) and a mean follow-up period of 4.4 ± 3.5 years. Seventeen patients had an associated transverse acetabular fracture, and an anterior columnar screw was used for additional fixation. Functional outcome was assessed using the Oxford hip score (OHS). Radiological assessment was undertaken for the images done immediately post-operatively and at the last follow-up. Patients with advanced post-traumatic arthritis and complications such as avascular necrosis (AVN), nerve injuries, non-union, heterotopic ossification and fixation failure were identified. The hazard rate of re-operation on the native hip was estimated using the life tables. Kaplan Meier analysis was used to assess survival with THR or excision arthroplasty as an endpoint.

RESULTS

Six patients underwent a total hip replacement: secondary to AVN in four and infection in two patients. The hazard of THR was estimated at 6% (SE = 0.02) during the first three years, then decreased dramatically afterwards. The five-year survival of native hip was 83% (SE = 0.06). Native hip was expected to survive for 10.67 years (95% CI 9.49-11.83) without joint replacement. The mean OHS in our cohort was 33.66 (3-48), and 29 patients (61.70%) had an OHS of more than 30.

CONCLUSION

The use of spring plates to fix multifragmentary posterior wall fractures has excellent mid-term results, high survivorship and a low complication rate. Combining an anterior columnar screw and a posterior spring plate has shown to be a suitable fixation construct in selected patients with associated transverse acetabular fractures. A longer-term follow-up with a larger cohort using this fixation construct is needed.

Evaluation and Management of Posterior Wall Acetabulum Fractures

Posterior wall acetabulum fractures typically result from high-energy mechanisms and can be associated with various orthopaedic and nonorthopaedic injuries. They range from isolated simple patterns to multifragmentary with or without marginal impaction. Determination of hip stability, which can depend on fragment location, size, and displacement, directs management. Although important in the assessment of posterior wall fractures, CT is unreliable when used to determine stability. The dynamic fluoroscopic examination under anesthesia (EUA) is the benchmark in assessment of hip stability, and fractures deemed stable by EUA have good radiographic and functional outcomes. In fractures that meet surgical criteria, accurate joint reduction guides outcomes. Joint débridement, identification and elevation of impaction, and adjunctive fixation of posterosuperior and peripheral rim fragments along with standard buttress plate fixation are critical. Complications of the fracture and surgical fixation include sciatic nerve injury, posttraumatic osteoarthritis, osteonecrosis of the femoral head, and heterotopic ossification. Although accuracy of joint reduction is paramount for successful results, other factors out of the surgeon's control such as comminution, femoral head lesions, and dislocation contribute to poor outcomes. Even with anatomic restoration of the joint surface, good clinical outcomes are not guaranteed and residual functional deficits can be expected.

Clinical and functional outcomes of posterior wall fractures of the acetabulum fixed with spring plates by a posterolateral rotator-sparing approach

BACKGROUND

Posterior wall fractures are the most frequent and account for up to 25% of all acetabular fractures, open reduction and internal fixation by a Kocher Langenbeck approach is the gold standard for this injury but even with anatomic reduction poor outcomes are higher than expected, The present study proposes a technique for open reduction and internal minimizing soft tissue and periosteal injury through a modified Kocher-Langenbeck and spring plate fixation.

METHODS

This case series, descriptive, longitudinal study assessed the clinical and functional outcomes of patients with isolated posterior wall fractures of the acetabulum, the study included 24 consecutive patients from January to December 2018 who underwent open reduction and internal fixation with spring plates by a Rotator Sparing Kocher Langenbeck approach RESULTS: Clinical and radiographic assessment at 3 and 12 months using the Harris Hip Score (HHS), Merle d'Aubigné and Postel (MDP) score, and EQ-5D-3L score.

RESULTS

Twenty-four patients were included in the study (5 females [20.8%], 19 males [79.2%]; mean age, 33.5 ± 13.1 years; range: 15-64 years). 41.7% of patients were admitted for hip dislocation, with 75% of these presenting a displacement greater than 20 mm; 21% for marginal impaction; 8.3% for acetabular dome involvement; and 25% for femoral head involvement. Based on the HHS, MDP, and EQ-5D-3L scores, the 12-month follow-up showed excellent outcomes in 95.8% of patients, and only one patient presented a poor functional outcome that was associated with posttraumatic arthrosis due to sequelae of femoral head necrosis.

CONCLUSIONS

Excellent and good outcomes are considerably higher with this technique compared to previous papers in the literature. It is still early to assess femoral head necrosis and osteoarthritis, but these are promising results.

LEVEL OF EVIDENCE

IV.

Fragment-specific fixation of posterior wall acetabular fractures

PURPOSE

Fractures of the posterior wall (PW) of the acetabulum have a wide variety of patterns; treating them as a single entity using the standard ilio-ischial plate would be inappropriate. We are presenting our experience with a fragment-specific fixation technique in which each PW fragment is reduced and fixed with separate buttress/anti-glide plate(s) in a tailored fashion, abandoning the use of the ilio-ischial plate.

PATIENTS AND METHODS

Fragment-specific fixation was applied to 46 patients with PW fractures (33 simple and 13 associated fracture types) with a mean follow-up of 34.9 ± 20.5 months (range: 12-72). Kocher-Langenbeck approach was utilized for all patients with dissection limited to the fracture site (a limited form of the approach was used in three patients).

RESULTS

Anatomical reduction of the fracture was achieved in 41 (89.1%) patients, imperfect reduction in four (8.7%), and poor reduction in one (2.2%) patient. Excellent to good radiological and functional results were achieved in 91.3% of cases. A single case had recurrent subluxation which was related to avascular necrosis of the highly comminuted wall fragments. Four patients developed post-traumatic arthritis and required total hip arthroplasty. None of our cases developed clinically significant heterotopic bone formation.

CONCLUSION

With a versatile yet a strong-enough construct and limited soft tissue dissection, fragment-specific fixation yielded very good results with few complications.

[Application of new H-shaped anatomical titanium plate for posterior wall/posterior column acetabular fractures]

Objective

To explore the effectiveness of a new H-shaped anatomical titanium plate in treatment of posterior wall/posterior column acetabular fractures.

Methods

Between March 2012 and April 2019, 46 patients with acetabular fractures involving posterior wall/posterior column were treated with the new H-shaped anatomical titanium plates. There were 28 males and 18 females. The age ranged from 20 to 70 years, with an average of 45.5 years. Among the patients, 34 cases were injured by traffic accidents and 12 cases by falling from height. The time from injury to operation ranged from 2 to 14 days, with an average of 7 days. According to Letournel-Judet classification, there were 12 cases of posterior wall fractures, 1 case of posterior column fracture, 3 cases of transverse fractures, 9 cases of transverse fractures involving posterior walls, 8 cases of posterior column and posterior wall fractures, 2 cases of anterior column and posterior semi-transverse fractures, 3 cases of T-shaped fractures, and 8 cases of double column fractures. Matta reduction standard was used to evaluate fracture reduction and Merle d'Aubign-Postel score was used to evaluate hip joint function.

Results

All operations were successfully completed. The time of posterior operation was 60-120 minutes, with an average of 80 minutes. The amount of intraoperative blood loss ranged from 200 to 600 mL, with an average of 300 mL. All the incisions healed by first intention and no infection, deep vein thrombosis, or sciatic nerve injury occurred. All 46 patients were followed up 6-72 months, with an average of 37 months. According to Matta reduction standard, 40 cases obtained anatomic reduction, 4 cases satisfactory reduction, 2 cases unsatisfactory reduction, and the satisfaction rate was 95.7% (44/46). All fractures healed, and the healing time was 3-6 months, with an average of 4.3 months. No internal fixation failure occurred during the follow-up. At last follow-up, the Merle d'Aubign-Postel score ranged from 6 to 18 (mean, 15.5), including 38 cases of excellent, 4 cases of good, 2 cases of fair, and 2 cases of poor, with an excellent and good rate of 91.3% (42/46). Heterotopic ossification occurred in 4 cases, traumatic arthritis in 4 cases, and osteonecrosis of femoral head in 2 cases after operation.

Conclusion

For acetabular fractures involving posterior wall/posterior column, the new H-shaped anatomical titanium plate can provide stable fixation, satisfactory reduction, and good recovery of hip function.

Accuracy of Posterior Wall Acetabular Fracture Lag Screw Placement: Correlation Between Intraoperative Fluoroscopy and Postoperative Computer Tomography

OBJECTIVE

Compare intraoperative "on end" fluoroscopy lag screw position to postoperative computer tomography.

DESIGN

Retrospective review.

CLINICAL SETTING

Level 1 trauma center.

PATIENTS

One hundred sixteen patients sustaining operative acetabular fractures with posterior wall components.

INTERVENTION

Posterior wall lag screws placed using "on end" fluoroscopic imaging.

MAIN OUTCOME MEASUREMENTS

The primary outcome was determining correlation between lag screw position, in relation to the acetabular articular margin, using intraoperative fluoroscopy and postoperative computer tomography. Analysis was performed based on location around the acetabulum, including posterior (P), superoposterior (SP), and superior (S) regions, and screws 0-5, 5-10, and >10 mm from the joint.

RESULTS

Two hundred forty-four lag screws were identified as follows: 51.6% in the P group, 25.4% in SP, and 23.0% in the S group with excellent correlation noted in all groups. For screws pooled based on fluoroscopic distance from the joint, 28.3% were 0-5 mm, 52.9% 5.01-10 mm, and 18.4% >10 mm. Correlation coefficients were 0.60 for 0-5 mm and 0.68 for both groups >5 mm. Subdividing screws based on anatomic region and fluoroscopic location found increasing correlation as screws moved further from the joint in the P region. In the SP group, excellent correlation was noted for screws 0-5 mm with decreasing correlation further from the joint. Within the S group, correlation for screws 0-5 mm did not reach significance, but good correlation was noted for screws >5 mm. Overall incidence of intraarticular screws was 1.2%.

CONCLUSIONS

Intraoperative axial fluoroscopy for posterior wall lag screw placement correlates closely with postoperative computer tomography allowing for reliable posterior wall lag screw placement in all regions around the acetabulum. Care should be taken while placing lag screws within 5 mm of the articular surface, particularly within the posterior region.

Fragment specific fixation technique using 2.7 mm VA LCP for comminuted posterior wall acetabular fractures: a novel surgical technique

PURPOSE

The purposes of the study were to introduce surgical technique of fragment-specific fixation technique using multiple 2.7-mm variable-angle locking compression plates (VA LCPs) in comminuted posterior wall acetabular fractures and reported its clinical results.

PATIENTS AND METHODS

Among the 68 patients, 23 with comminuted posterior wall factures with ≥ 3 fragments in the CT scan and no column involvement with a minimum follow-up duration of 12 months were enrolled in this study. We evaluated the clinical results after the treatment of comminuted posterior wall acetabular fractures via the fragment-specific fixation technique using 2.7-mm variable-angle locking compression plates (VA LCPs) retrospectively.

RESULTS

The average duration of follow-up was 26.8 months. Anatomical reduction was achieved in eighteen patients. Imperfect reduction was achieved in five patients. 22 patients achieved fracture union and one patient underwent revision surgery owing to acute postoperative infection. There were no complications, including loss of reduction, fixative failures, sciatic nerve palsy, heterotopic ossification, and early posttraumatic arthritis among 22 patients. The average functional outcome was measured as 'very good'.

CONCLUSION

Fragment-specific fixation technique using 2.7-mm VA LCPs for comminuted posterior wall acetabular fractures could be an acceptable alternative means of surgical fixation.

Surgical Treatment for Posterior Dislocation of Hip Combined with Acetabular Fractures Using Preoperative Virtual Simulation and Three-Dimensional Printing Model-Assisted Precontoured Plate Fixation Techniques

Background and Purpose

Hip dislocation combined with acetabular fracture remains a challenging condition for orthopedic surgeons. In this study, we utilized a computer-assisted simulation and three-dimensional (3D) printing technology to treat patients with hip dislocation combined with acetabular fracture. We hypothesized that the 3D printing-assisted method would shorten the internal fixation time and surgical time.

Methods

We retrospectively reviewed 16 patients diagnosed with traumatic posterior dislocation of hip combined with acetabular fractures and treated with plate fixation from September 2013 to August 2017. Patients were divided into two groups: (1) traditional method and (2) 3D printing groups. In the traditional method group, the plates were contoured during the surgery, whereas in the 3D printing group, the patient's pelvic computed tomography image was transformed to the 3D medical image software for processing preoperatively. The fracture reduction was simulated by the computer. Thereafter, the 1:1 scale 3D printing model was used to design the surgical plan and contour patient-specific plates preoperatively.

Results

The internal fixation time was significantly shorter in the 3D printing group than in the traditional method group (-33 min, P<0.05). The mean operative time was shorter than that in the traditional method group (-43 min). However, blood loss and postoperative radiograph results were similar between the groups. The complication rate was lower in the 3D printing group (2/7) than in the traditional method group (5/9).

Interpretation

Computer-assisted simulation with 3D printing technology is a more efficient method for treating hip dislocation combined with acetabular fractures.