Comparative study of W-shaped angular plate and reconstruction plate in treating posterior wall fractures of the acetabulum

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.

Posterior wall fractures of the acetabulum: treatment using an anatomical plate through direct posterior approach

OBJECTIVES

This study was aimed to measure the application of W-shaped acetabular angular plate (WAAP) through direct posterior approach (DPA) on the reconstruction of acetabular posterior wall fractures when compared with reconstruction plates.

PATIENTS AND METHODS

A retrospective study was performed on patients treated with the WAAP or reconstruction plates via the DPA. The intraoperative data of operative time, blood loss and radiation exposure times were recorded. Radiographs of the pelvis and CT scan were obtained within one week post-operation to assess the reduction quality. The clinical outcome was evaluated by the modified Merle d'Aubigne and Postel score.

RESULTS

From May 2016 to October 2019, a total of 41 patients with simple acetabular posterior wall fractures were included in this study, 22 from the WAAP group and 19 from the reconstruction plates group. There were no significant differences between the two group in age, gender, time from injury to operation, cause of injuries, length of incision and follow-up time (P > 0.05). In comparison with the reconstruction plates group, the average operation time of the WAAP group was significantly shorter (46.1 ± 12.7 min vs 59.2 ± 17.4 min, P < 0.05), the average radiation exposure times were significantly less (2.3 ± 0.6 vs 3.6 ± 1.0, P < 0.001), the average blood loss was significantly less (240 ± 98.9 ml vs 301.1 ± 66.6 ml, P < 0.05). According to Matta radiology criteria and the modified Merle d' Aubigne and Postel score, no significant difference was observed between the two group, as for the quality of reduction and function outcomes.

CONCLUSION

The application of WAAP through DPA showed satisfactory preliminary clinical outcomes, showing promise to be an alternative technique for the treatment of acetabular posterior wall fractures.

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

Background

Complex acetabular fractures involving the anterior and posterior columns are an intractable clinical challenge. The study investigated the safety and efficacy of oblique-ilioischial plate technique for acetabular fractures involving low posterior column.

Methods

A retrospective analysis of 18 patients operated with the oblique-ilioischial plate technique by the modified Stoppa approach (or combined with iliac fossa approach) between August 2016 and July 2021 for low posterior column acetabular fractures was conducted. The anterior column was fixed with a reconstructed plate from the iliac wing along the iliopectineal line to the pubis. The low posterior column was fixed with the novel oblique-ilioischial plate running from the ilium to the ischial ramus. Operative time, intraoperative blood loss, reduction quality, and postoperative hip function were recorded.

Results

Out of the 18 patients, 10 were male and 8 were female. The mean age was 48.6±10.2 years (range: 45–62 years); The mean interval from injury to operation was 7.2±1.4 days (range: 5–19 days); The mean operative time was 2.1±0.3 h (range: 1.0–3.2 hours); The mean intraoperative blood loss was 300±58.4 mL (range: 200–500 mL). Postoperative reduction (Matta’s criteria) was deemed as excellent (n = 9), good (n = 4), and fair (n = 5). At the final follow-up, the hip function (modified Merle d’Aubigne-Postel scale) was deemed as excellent (n = 11), good (n = 3), and fair (n = 4). The mean union time was 4.5±1.8 months (range: 3–6 months). No implant failure, infection, heterotopic ossification, or neurovascular injury were reported.

Conclusion

The oblique-ilioischial plate technique via anterior approach for acetabular fractures involving low posterior column offers reliable fixation, limited invasion, little intraoperative bleeding, and fewer complications. However, larger multicenter control studies are warranted.

Comparative study of anatomical locking plate and reconstruction plate in treating acetabular fractures

PURPOSE

This study aims to compare the effectiveness of anatomic locking plate and reconstruction plate used in treating acetabular fractures.

METHODS

From January 2009 to January 2016, patients with acetabular fractures were included in this retrospective study. We grouped the patients into two groups based on the internal fixation: reconstruction plate group (RPG) and anatomic locking plate group (ALPG). The operation time, blood loss, intra-operative screw penetration, and plate breakage were compared between the two groups. The intra-operative fluoroscopic images were used to evaluate the fixation location. The quality of reduction and radiological grading were assessed according to the criteria developed by Matta. The clinical assessment was based on the Merle d'Aubigne-Postel score.

RESULTS

Eighty-three patients were included in this study and were followed up for an average of 35 months (range, 25 to 42 months). Thirty-five patients were treated with the anatomical locking plate, and 48 patients were treated with the reconstruction plate. The mean surgical time was significantly shorter (P < 0.0001) in ALPG patients than in RPG patients, and the intra-operative blood loss was significantly lower (P = 0.008). The rates of intra-operative screw penetration or plate breakage in the ALPG (0/35) are significantly lower than that in the RPG (7/48) (P = 0.018). Post-operative Matta score (P = 0.905), Merle d'Aubigne-Postel score (P = 0.957), and overall complication rates (P = 0.391) were not significantly different among the groups.

CONCLUSION

Patients treated by anatomical locking plate had shorter operation time, less bleeding, and lower rate screw perforation compared to patients treated by reconstruction plate. Anatomical locking plate is a better choice for acetabulum fractures, especially complicated fractures.

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.

Crescent Technique with Dual C-Shaped Reconstruction Plates for Posterior Acetabular Wall Fractures

Background: Here we have defined a novel technique for repairing posterior acetabular wall fractures called the "crescent technique," in which dual C-shaped reconstruction plates overlap at the distal ends and, if necessary, at the proximal ends. We also analyzed the efficacy and reliability of this method. Patients and Methods: This was a retrospective analysis of 27 patients undergoing the crescent technique. All of the fractures were treated by the senior author for a mean of 7.9 days (0-15 days) after the trauma. The mean follow-up period was 19 months (13-29 months). The clinical results were evaluated using the modified clinical grading system developed by Merle d'Aubigne and Postel, and then modified by Matta. The radiographs were graded according to the criteria described by Matta. Results: In the clinical grading, 16 (59%) of the patients were excellent and very good, 5 (19%) were good, 3 (11%) were moderate, and 3 (11%) were poor. According to the Matta radiological evaluation criteria, 19 (70%) were excellent, 4 (15%) were good, 4 (15%) were fair, and none were poor. Statistically significant consistency was seen between the clinical and radiological results (p = 0.002). Conclusions: The crescent technique is a dual plate technique modification that can provide a stable fixation. It appears to be an effective and reliable method for treating posterior wall fractures of the acetabulum.

Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis

Objective

The purpose of this study was to compare the stability and feasibility of four fixation constructs in a posterior column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate.

Methods

Twenty embalmed cadaveric pelvises with a posterior column acetabular fractures were allocated to one of four groups: 1) a reconstruction plate, 2) a reconstruction plate with a posterior column lag screw, 3) double reconstruction plates, and 4) a W-shaped acetabular angular plate. These constructs were mechanically loaded on a testing machine, and construct stiffness values were measured. Strain gauges were utilized to measure the mechanical behavior in the condition of compressive force.

Results

Final stiffness was not different between the two reconstruction plates (445.81±98.30 N/mm) and the W-shaped acetabular angular plate (447.43±98.45 N/mm, p = 0.524), both of which were superior to a single reconstruction plate (248.90±61.95 N/mm) and a combined plate and lag screw (326.41±94.34 N/mm). Following the fixation of the W-shaped acetabular angular plate, the strain distribution was similar to the intact condition around the acetabulum. The parameters of the W-shaped acetabular angular plate that were observed at the superior region of the acetabulum were less than those of a single reconstruction plate (p<0.05), a single reconstruction plate with lag screw (p<0.05), and two reconstruction plates (p<0.05).

Conclusions

The novel W-shaped acetabular angular plate fixation technique was able to provide the biomechanically stiffest construct for stabilization of a posterior column acetabular fracture; it also resulted in a partial restoration of joint loading parameters toward the intact state.

Early Versus Late Weight-Bearing Protocols for Surgically Managed Posterior Wall Acetabular Fractures

Despite overall improved outcomes with open reduction and internal fixation of acetabular fractures, posterior wall fractures show disproportionately poor results. The effect of weight bearing on outcomes of fracture management has been investigated in many lower extremity fractures, but evidence-based recommendations in posterior wall acetabular fractures are lacking. The authors systematically reviewed the current literature to determine if a difference in outcome exists between early and late postoperative weight-bearing protocols for surgically managed posterior wall acetabular fractures. PubMed and MEDLINE were searched for posterior wall acetabular fracture studies that included weight-bearing protocols and Merle d'Aubigné functional scores. Twelve studies were identified. Each study was classified as either early or late weight bearing. Early weight bearing was defined as full, unrestricted weight bearing at or before 12 weeks postoperatively. Late weight bearing was defined as restricted weight bearing for greater than 12 weeks postoperatively. The 2 categories were then compared by functional score using a 2-tailed t test and by complication rate using chi-square analysis. Six studies (152 fractures) were placed in the early weight-bearing category. Six studies (302 fractures) were placed in the late weight-bearing category. No significant difference in Merle d'Aubigné functional scores was found between the 2 groups. No difference was found regarding heterotopic ossification, avascular necrosis, superficial infections, total infections, or osteoarthritis. This systematic review found no difference in functional outcome scores or complication rates between early and late weight-bearing protocols for surgically treated posterior wall fractures. [Orthopedics. 2017: 40(4):e652-e657.].

Locking Compression Pilon Plate for Fixation of Comminuted Posterior Wall Acetabular Fractures: A Novel Technique

Posterior wall acetabular fractures involving a large portion the wall's width and with extensive comminution are difficult fractures to manage operatively. Cortical substitution with a pelvic reconstruction plate and supplemental spring plates has been the traditional means of fixation for these fractures. This option, however, requires the use of multiple, unlinked plates and provides no reliable option for peripheral fixation in comminuted fragments. We describe a novel technique for operative fixation of large, comminuted posterior wall fractures using a single distal tibia pilon plate with the option for peripheral locking screw fixation and report on a series of 20 consecutive patients treated with this method.

Treatment of Unstable Posterior Pelvic Ring Fracture with Pedicle Screw-Rod Fixator Versus Locking Compression Plate: A Comparative Study

Background

The aim of this study was to assess the clinical results of treatment for unstable posterior pelvic fractures using a pedicle screw-rod fixator compared to use of a locking compression plate.

Material/Methods

A retrospective study was performed between June 2010 and May 2014 and the data were collected from 46 patients with unstable posterior pelvic ring fractures. All patients were treated using either a pedicle screw-rod fixator (study group, 24 patients) or locking compression plate (control group, 22 patients). In these patients, causes of injury included traffic accidents (n=27), fall from height (n=12), and crushing accidents (n=7). The quality of reduction and radiological grading were assessed. Clinical assessments included the operation time, times of X-ray exposures, bleeding volume during operation, incision length, and Majeed postoperative functional evaluation.

Results

No iatrogenic neurovascular injuries occurred during the operations in these 2 groups. The average follow-up time was 24.5 months. All fractures were healed. The significant differences (P<0.05) between the 2 groups were operation duration, size of incision, and intraoperative bleeding volume. Statistically significant differences in the Majeed postoperative functional evaluation and times of X-ray exposures were not found between the 2 groups.

Conclusions

Similar clinical effects were achieved in treating the posterior pelvic ring fractures using the pedicle screw-rod fixator and the locking compression plate. However, the pedicle screw-rod fixator has the advantages of smaller incision, shorter duration of the operation, and less bleeding volume compared to using the locking compression plate.