Preliminary Clinical Study on the Treatment of Acetabular Quadrilateral Fractures With a Novel Anatomical Locking Plate
Authors: Zhou Runtao , Yang Mingming , Liang Anlin , Gao Shichang 
Published: December 2024

Objective
This study aimed to investigate the surgical approaches, clinical efficacy, and indications of a novel acetabular anatomical locking plate for acetabular fractures involving the quadrilateral plate.

Methods
Patients with acetabular fracture treated with the novel acetabular quadrilateral anatomical locking plates in our department from December 2017 to June 2020 were collected. According to the fracture types, a 1:1 matched-pair analysis was carried out and patients treated with reconstruction plates were selected. These 2 groups of patients were included in the observation group and control group, respectively, and ultimately each group included 11 patients. The time between injury and definitive surgery, surgical approaches, operation time, intraoperative blood loss volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, fracture union time, reduction loss, and postoperative complications were recorded. The fracture reduction quality and hip function were respectively evaluated by Matta’s grading system and the modified Merle D’Aubigne-Postel grading system. A comparison was made to observe whether the 2 groups had differences in the preceding clinical parameters.

Results
As for the observation group, the mean operation time was 327.82 ± 137.46 min (range: 120～580 min; median: 323 min), the mean intraoperative blood loss volume was 1745.46 ± 2103.98 mL (range: 300～7000 mL; median: 1000 mL), and the mean intraoperative blood transfusion volume was 1526.18 ± 1617.46 mL (range: 0～5130 mL; median: 900 mL), and the mean postoperative blood transfusion volume was 254.55 ± 439.01 mL (range：0～1400 mL; median：0 mL). During the follow-up period ranging from 9 to 28 months, 1 incision lipoliquefaction, 1 heterotopic ossification, and 1 traumatic arthritis were recorded. According to Matta’s grading system, 4 anatomic reductions, 6 imperfect reductions, and 1 poor reduction were recorded, and the rate of satisfactory reduction quality was 90.91%. According to the modified Merle D’Aubigne-Postel grading system, 5 excellent, 4 good, 1 fair, and 1 poor were recorded, and the rate of satisfactory hip function was 81.82%. As for the control group, the mean operation time was 273.18 ± 99.15 min (range: 120～450 min; median: 270 min), the mean intraoperative blood loss volume was 1122.73 ± 469.77 mL (range: 300～1500 mL; median: 1500 mL), and the mean intraoperative blood transfusion volume was 608.55 ± 363.71 mL (range: 0～1086 mL; median: 758 mL), the mean postoperative blood transfusion volume was 281.82 ± 430.86 mL (range：0～1000 mL; median：0 mL). During the follow-up period ranging from 9 to 42 months, 2 instances of traumatic arthritis and 1 femoral head necrosis were recorded. According to Matta’s grading system, 2 anatomic reductions, 6 imperfect reductions, and 3 poor reductions were recorded, and the rate of satisfactory reduction quality was 72.73%. According to the modified Merle D’Aubigne-Postel grading system, 1 excellent, 7 good, 0 fair, and 3 poor were recorded, and the rate of satisfactory hip function was 72.73%. All the patients obtained fracture union, and no reduction loss was recorded. According to statistical analysis, there were no significant differences between the 2 groups in the time between the injury and definitive surgery, surgical approaches, intraoperative blood loss volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, rate of satisfactory reduction quality, hip function score, and rate of satisfactory hip function.

Conclusions
Through 3 kinds of anterior approaches, the novel anatomical locking plate can be used to fix acetabular fractures involving the quadrilateral plate including anterior wall fractures, anterior column fractures, transverse fractures, and double-column fractures, which can obtain satisfactory fracture reduction quality, limit the medial displacement of the quadrilateral plate effectively, restore the postoperative hip function well, and obtain a comparable clinical efficacy as the reconstruction plate.