S'abonner

A new internal fixation technique for acetabular fractures involving the quadrilateral plate - 18/12/19

Doi : 10.1016/j.otsr.2019.09.026 
Guo-Chun Zha a, , Du-Man Tulumuhan b, Tao Wang c, Guo-Yang Wan d, Yong Wang e, Jun-Ying Sun f
a Department of Orthopedic Surgery, the Affiliated Hospital of Xuzhou Medical University, No. 99, Huaihai West Road, 221002 Xuzhou, Jiangsu, P.R. China 
b Department of Orthopedic Surgery, Kuitun Hospital of Yi Li Kazak Autonomous Prefecture, No. 32, Tacheng Street, 833200 Yi Li Kazak Autonomous Prefecture, Xinjiang Uygur Autonomous Region, P.R. China 
c Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Ruijin 2nd Road, 200025 Shanghai, P. R. China 
d Department of Orthopedic Surgery, the Affiliated Suzhou hospital of Nanjing Medical University, 242, Guangji Road, 215006 Suzhou, Jiangsu, P.R. China 
e Department of Orthopedic Surgery, Yixing People's Hospital, 75, Tong zhen Road, 214200 Yi xing, Jiangsu, P.R. China 
f Orthopaedic Department, the First Affiliated Hospital of Soochow University, 188, Shizi Street, 215006 Suzhou, Jiangsu, P.R. China 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 18 December 2019
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

The treatment of acetabular fracture involving the quadrilateral plate is a technical challenge, and the optimal management of the fracture remains controversial. We have designed a new implant (named acetabular fracture reduction internal fixator, AFRIF) for acetabular fractures involving the quadrilateral plate. This use of this new device was not investigated therefore we conducted a retrospective study aiming to determine whether the AFRIF can achieve satisfactory clinical and radiological outcomes for quadrilateral plate fracture.

Hypothesis

The AFRIF for quadrilateral plate fracture is an acceptable option to treat acetabular fracture involving the quadrilateral plate.

Materials and methods

We performed a retrospective analysis of prospectively collected data on 24 patients (15 males and 9 females) with acute displaced quadrilateral plate fractures of the acetabulum who were treated by the AFRIF between August 2011 and May 2015. The mean age of the patients was 61.5±9.2 years (range, 31–82 years). All hips had protrusion of the femoral head, of these 5 hips with associated articular impaction of the medial roof. The type of fractures included anterior column in 4, anterior column+posterior hemitransverse in 3, associated both column in 11, T-shaped in 6 patients. The approaches included Limited Ilioinguinal (5 patients) and Limited Standard-Ilioinguinal combined with Kocher-Langenbeck (19 patients). Quality of reduction was evaluated and graded as anatomical (0mm to 1mm of displacement), imperfect (2mm to 3mm displacement) or poor (more than 3mm displacement) according to the residual displacement as defined by Matta. The final follow-up clinical outcome was classified as excellent (18 points), good (15–17 points), fair (13–14 points) or poor (<13 points) in terms to the modified Merle d’Aubigné-Postel score, and radiological outcomes evaluation were as excellent, good, fair, or poor based on Matta score.

Results

The mean duration of follow-up was 45.7±13.0 months (range, 24–60 months). Average operative time and bleeding amount was 110.3±30.8min (range, 105–210min) and 950.6±348.6ml (range, 300–1500ml), respectively. There was anatomical reduction in 17 patients (17/24, 70.8%), imperfect in 5 patients (5/24, 20.8%), and poor in 2 patients (2/24, 8.3%). All of the quadrilateral plate fractures achieved anatomical except one imperfect reduction. No re-protrusion of the femoral head was observed at the final follow-up. The mean modified Merle d’Aubigné-Postel score was 16.9±2.0 points (range, 10–18 points), and 83.3% (20 of 24) have good or excellent radiological outcomes.

Discussion

The findings suggest that the AFRIF for quadrilateral plate fractures may prevent protrusion of the femoral head and achieve good to excellent clinical and radiological outcomes.

Level of evidence

IV, retrospective study.

Le texte complet de cet article est disponible en PDF.

Keywords : Acetabulum fracture, Quadrilateral plate, Medial wall


Plan


© 2019  Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2024 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.