BIOMECHANICAL COMPARATIVE STUDY ON FOUR INTERNAL FIXATIONS FOR ACETABULAR FRACTURES IN QUADRILATERAL AREA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGLei ¹ ,  WUXiaobo ² , QIWei ² , WANGYongbin ³ , HEQuanjie ¹ , XUFengsong ¹ , LIUHongyang ¹

1. 華北理工大學（河北唐山, 063000）公共衛生學院;
2. School of Graduate, 3 School of Public Health, North China University of Science and Technology, Tangshan Hebei, 063000, P. R. China;
3. Department of Orthopaedics and Traumatology, the Second Hospital of Tangshan(North China University of Science and Technology Affiliated Orthopedic Hospital);

Corresponding?author：

WUXiaobo, Email: drwuxiaobo@foxmail.com

Keywords：

Acetabular fracture in quadrilateral area; Internal fixation; Reconstruction plate; Lag screw; Biomechanics

DOI：

10.7507/1002-1892.20150268

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Objective To compare the biomechanical difference of 4 kinds of internal fixations for acetabular fracture in quadrilateral area. Methods The transverse fracture models were created in 16 hemipelves specimens from 8 adult males, and were randomly divided into 4 groups according to different internal fixation methods (n=4): infrapectineal buttress reconstruction plate (group A), infrapectineal buttress locking reconstruction plate (group B), reconstruction plate combined with trans-plate quadrilateral screws (group C), and anterior reconstruction plate-lag screw (group D). Then the horizontal displacement, longitudinal displacement of fractures, and axial stiffness were measured and counted to compare the stability after continuous vertical loading. Results Under the same loading, the horizontal and longitudinal displacements of groups A, B, C, and D were decreased gradually; when the loading reached 1 800 N, the longitudinal displacement of group A was more than 3.00 mm, indicating the failure criterion, while the axial stiffness increased gradually. Under 200 N loading, there was no significant difference (P>0.05) in horizontal displacement, longitudinal displacement, and axial stiffness among 4 groups. When the loading reached 600-1 800 N, significant differences were found in horizontal displacement, longitudinal displacement, and axial stiffness among 4 groups (P<0.05) except the horizontal displacement between groups C and D (P>0.05). Conclusion For acetabular fracture in the quadrilateral area, anterior reconstruction plate-lag screw for internal fixation has highest stability, followed by reconstruction plate combined with trans-plate quadrilateral screws, and they are better than infrapectineal buttress reconstruction plate and infrapectineal buttress locking reconstruction plate.

Citation： WANGLei, WUXiaobo, QIWei, WANGYongbin, HEQuanjie, XUFengsong, LIUHongyang. BIOMECHANICAL COMPARATIVE STUDY ON FOUR INTERNAL FIXATIONS FOR ACETABULAR FRACTURES IN QUADRILATERAL AREA. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1235-1239. doi: 10.7507/1002-1892.20150268 Copy

1.	El-khadrawe TA, Hammad AS, Hassaan AE. Indicators of outcome after internal fixation of complex acetabular fractures. Alexandria Journal of Medicine, 2012, (48):99-107.
2.	Tannast M, Siebenrock KA. Operative treatment of T-type fractures of the acetabulum via surgical hip dislocation or Stoppa approach. Oper Orthop Traumatol, 2009, 21(3):251-269.
3.	Sen RK, Tripathy SK, Aggarwal S, et al. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach. Injury, 2013, 44(2):266-273.
4.	蔡賢華, 劉曦明, 汪國棟, 等. 前路鈦板結合方形區螺釘內固定治療涉及方形區的髖臼骨折. 中華創傷骨科雜志, 2013, 15(2):102-106.
5.	宋朝暉. 髖臼骨折對髖關節生物力學行為的影響及相關研究. 石家莊:河北醫科大學, 2004.
6.	Ebraheim NA, Rongming X, Biyani A, et al. Anatomic basis of lag screw placement in the anterior column of the acetabulum. Clin Orthop Relat Res, 1997, (339):200-205.
7.	Chang JK, Gill SS, Zura RD, et al. Comparative strength of three methods of fixation of transverse acetabular fractures. Clin Orthop Relat Res, 2001, (392):433-441.
8.	吳嘯波, 張奇, 郭明珂, 等. 髖臼后柱骨折不同方式鋼板內固定的穩定性研究. 第三軍醫大學學報, 2010, 32(7):665-668.
9.	Bray TJ, Esser M, Fulkerson L. Osteotomy of the trochanterin open reduction and internal fixation of acetabular fractures. J Bone Joint Surg (Am), 1987, 69(5):711-717.
10.	Mehin R, Jones B, Zhu Q, et al. A biomechanical study of conventional acetabular internal fracture fixation versus locking plate fixation. Can J Surg, 2009, 52(3):221-228.
11.	Kaku N, Tsumura H, Taira H, et al. Biomechanical study of load transfer of the pubic ramus due to pelvic inclination after hip joint surgery using a three-dimensional finite element model. J Orthop Sci, 2004, 9(3):264-269.
12.	Ayoub M. Is it possible that most of the displaced acetabalar fractures can be managed through a single ilioinguinal approach? 2-7 years experience results. Eur J Orthop Surg Traumatol, 2011, 21: 259-267.
13.	Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res, 1994, (305):112-123.
14.	Archdeacon MT, Kazemi N, Guy P, et al. The modified Stoppa approach for acetabular fracture. J Am Acad Orthop Surg, 2011, 19(3):170-175.
15.	Bible JE, Choxi AA, Kadakia RJ, et al. Quantification of bony pelvic exposure through the modified Stoppa approach. J Orthop Trauma, 2014, 28(6):320-323.
16.	Qureshi AA, Archdeacon MT, Jenkins MA, et al. Infrapectineal plating for acetabular fractures:a technical adjunct to internal fixation. J Orthop Trauma, 2004, 18(3):175-178.
17.	Sen RK, Tripathy SK, Aggarwal S, et al. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach. Injury, 2013, 44(2):266-273.
18.	Kistler BJ, Smithson IR, Cooper SA, et al. Are quadrilateral surface buttress plates comparable to traditional forms of transverse acetabular fracture fixation? Clin Orthop Relat Res, 2014, 472(11): 3353-3361.
19.	Vailas JC, Hurwitz S, Wiesel SW. Posterior acetabular fracture dislocations:fragment size, joint capsule, and stability. J Trauma, 1989, 29(11):1494-1496.

1. El-khadrawe TA, Hammad AS, Hassaan AE. Indicators of outcome after internal fixation of complex acetabular fractures. Alexandria Journal of Medicine, 2012, (48):99-107.
2. Tannast M, Siebenrock KA. Operative treatment of T-type fractures of the acetabulum via surgical hip dislocation or Stoppa approach. Oper Orthop Traumatol, 2009, 21(3):251-269.
3. Sen RK, Tripathy SK, Aggarwal S, et al. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach. Injury, 2013, 44(2):266-273.
4. 蔡賢華, 劉曦明, 汪國棟, 等. 前路鈦板結合方形區螺釘內固定治療涉及方形區的髖臼骨折. 中華創傷骨科雜志, 2013, 15(2):102-106.
5. 宋朝暉. 髖臼骨折對髖關節生物力學行為的影響及相關研究. 石家莊:河北醫科大學, 2004.
6. Ebraheim NA, Rongming X, Biyani A, et al. Anatomic basis of lag screw placement in the anterior column of the acetabulum. Clin Orthop Relat Res, 1997, (339):200-205.
7. Chang JK, Gill SS, Zura RD, et al. Comparative strength of three methods of fixation of transverse acetabular fractures. Clin Orthop Relat Res, 2001, (392):433-441.
8. 吳嘯波, 張奇, 郭明珂, 等. 髖臼后柱骨折不同方式鋼板內固定的穩定性研究. 第三軍醫大學學報, 2010, 32(7):665-668.
9. Bray TJ, Esser M, Fulkerson L. Osteotomy of the trochanterin open reduction and internal fixation of acetabular fractures. J Bone Joint Surg (Am), 1987, 69(5):711-717.
10. Mehin R, Jones B, Zhu Q, et al. A biomechanical study of conventional acetabular internal fracture fixation versus locking plate fixation. Can J Surg, 2009, 52(3):221-228.
11. Kaku N, Tsumura H, Taira H, et al. Biomechanical study of load transfer of the pubic ramus due to pelvic inclination after hip joint surgery using a three-dimensional finite element model. J Orthop Sci, 2004, 9(3):264-269.
12. Ayoub M. Is it possible that most of the displaced acetabalar fractures can be managed through a single ilioinguinal approach? 2-7 years experience results. Eur J Orthop Surg Traumatol, 2011, 21: 259-267.
13. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res, 1994, (305):112-123.
14. Archdeacon MT, Kazemi N, Guy P, et al. The modified Stoppa approach for acetabular fracture. J Am Acad Orthop Surg, 2011, 19(3):170-175.
15. Bible JE, Choxi AA, Kadakia RJ, et al. Quantification of bony pelvic exposure through the modified Stoppa approach. J Orthop Trauma, 2014, 28(6):320-323.
16. Qureshi AA, Archdeacon MT, Jenkins MA, et al. Infrapectineal plating for acetabular fractures:a technical adjunct to internal fixation. J Orthop Trauma, 2004, 18(3):175-178.
17. Sen RK, Tripathy SK, Aggarwal S, et al. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach. Injury, 2013, 44(2):266-273.
18. Kistler BJ, Smithson IR, Cooper SA, et al. Are quadrilateral surface buttress plates comparable to traditional forms of transverse acetabular fracture fixation? Clin Orthop Relat Res, 2014, 472(11): 3353-3361.
19. Vailas JC, Hurwitz S, Wiesel SW. Posterior acetabular fracture dislocations:fragment size, joint capsule, and stability. J Trauma, 1989, 29(11):1494-1496.

Chinese Journal of Reparative and Reconstructive Surgery

BIOMECHANICAL COMPARATIVE STUDY ON FOUR INTERNAL FIXATIONS FOR ACETABULAR FRACTURES IN QUADRILATERAL AREA

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