Application of new H-shaped anatomical titanium plate for posterior wall/posterior column acetabular fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Jiexin , LIAO Mingxin ,  CHEN Xiaojie

Department of Orthopedics, Nanping First Hospital Affiliated to Fujian Medical University, Nanping Fujian, 353000, P.R.China;

Corresponding?author：

CHEN Xiaojie, Email: fjsnpsdyyy@163.com

Keywords：

Acetabular fracture; posterior column fracture; posterior wall fracture; new H-shaped anatomical titanium plate; internal fixation

DOI：

10.7507/1002-1892.202007045

Video：

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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.

Citation： HUANG Jiexin, LIAO Mingxin, CHEN Xiaojie. Application of new H-shaped anatomical titanium plate for posterior wall/posterior column acetabular fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 64-69. doi: 10.7507/1002-1892.202007045 Copy

1.	楊述華, 傅德皓. 髖臼骨折. 創傷外科雜志, 2007, 9(1): 94-97.
2.	Letournel E. Acetabulum fractures: classification and management. J Orthop Trauma, 2019, 33(Suppl 2): S1-S2.
3.	Ebraheim NA, Patil V, Liu J, et al. Reconstruction of comminuted posterior wall fractures using the buttress technique: a review of 32 fractures. Int Orthop, 2007, 31(5): 671-675.
4.	Giannoudis PV, Tzioupis C, Moed BR. Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. J Bone Joint Surg (Br), 2007, 89(4): 503-509.
5.	Lee C, Johnson EE. Use of spring plates in fixation of comminuted posterior wall acetabular fractures. J Orthop Trauma, 2018, 32(Suppl 1): S55-S59.
6.	Askam B, Sims S. Supplemental superior buttress plating for the treatment of posterosuperior wall acetabulum fractures. J Orthop Trauma, 2019, 33(Suppl 2): S27-S31.
7.	Borg T, Hailer NP. Outcome 5 years after surgical treatment of acetabular fractures: a prospective clinical and radiographic follow-up of 101 patients. Arch Orthop Trauma Surg, 2015, 135(2): 227-233.
8.	Ziran BH, Little JE, Kinney RC. The use of a T-plate as “spring plates” for small comminuted posterior wall fragments. J Orthop Trauma, 2011, 25(9): 574-576.
9.	Lee AK, Wagner BR, McPhillips K, et al. Locking compression Pilon plate for fixation of comminuted posterior wall acetabular fractures: a novel technique. J Orthop Trauma, 2017, 31(1): e32-e36.
10.	Schwab JM, Zebrack J, Schmeling GJ, et al. The use of cervical vertebrae plates for cortical substitution in posterior wall acetabular fractures. J Orthop Trauma, 2011, 25(9): 577-580.
11.	Cho JW, Chung HJ, Kim BS, et al. Fragment specific fixation technique using 2.7 mm VA LCP for comminuted posterior wall acetabular fractures: a novel surgical technique. Arch Orthop Trauma Surg, 2019, 139(11): 1587-1597.
12.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
13.	Merle-d’Aubigne RM. Reposition with arthroplasty for congenital dislocation of the hip in adults. J Bone Joint Surg (Br), 1952, 34-B(1): 22-29.
14.	Firoozabadi R, Hamilton B, Toogood P, et al. Risk factors for conversion to total hip arthroplasty after acetabular fractures involving the posterior wall. J Orthop Trauma, 2018, 32(2): 607-611.
15.	Verbeek DO, van der List JP, Tissue CM, et al. Predictors for long-term hip survivorship following acetabular Archives of Orthopaedic and Trauma Surgery fracture surgery: importance of gap compared with step displacement. J Bone Joint Surg (Am), 2018, 100(11): 922-929.
16.	Siebenrock KA, Keel MJB, Tannast M, et al. Surgical hip dislocation for exposure of the posterior column. JBJS Essential Surgical Techniques, 2019, 9(1): e2.
17.	Sun DH, Zhao Y, Zhang JT, et al. Reconstruction of acetabular posterior wall fractures with extension to the roof using dual arc-shaped plates: A case report. Technol Health Care, 2017, 25(5): 1021-1024.
18.	Su K, Liu S, Wu T, et al. Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis. PLoS One, 2017, 12(11): e0187886.
19.	安維軍, 孫建斌, 李志忠. 自制彈簧鋼板在髖臼后壁骨折手術中的應用. 中國修復重建外科雜志, 2020, 34(1): 27-31.
20.	Li H, Yang H, Wang D, et al. Fractures of the posterior wall of the acetabulum: treatment using internal fixation of two parallel reconstruction plates. Injury, 2014, 45(4): 709-714.
21.	Iselin LD, Wahl P, Studer P, et al. Associated lesions in posterior wall acetabular fractures: not a valid predictor of failure. J Orthop Traumatol, 2013, 14(3): 179-184.
22.	Magu NK, Gogna P, Singh A, et al. Long term results after surgical management of posterior wall acetabular fractures. J Orthop Traumatol, 2014, 15(3): 173-179.

1. 楊述華, 傅德皓. 髖臼骨折. 創傷外科雜志, 2007, 9(1): 94-97.
2. Letournel E. Acetabulum fractures: classification and management. J Orthop Trauma, 2019, 33(Suppl 2): S1-S2.
3. Ebraheim NA, Patil V, Liu J, et al. Reconstruction of comminuted posterior wall fractures using the buttress technique: a review of 32 fractures. Int Orthop, 2007, 31(5): 671-675.
4. Giannoudis PV, Tzioupis C, Moed BR. Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. J Bone Joint Surg (Br), 2007, 89(4): 503-509.
5. Lee C, Johnson EE. Use of spring plates in fixation of comminuted posterior wall acetabular fractures. J Orthop Trauma, 2018, 32(Suppl 1): S55-S59.
6. Askam B, Sims S. Supplemental superior buttress plating for the treatment of posterosuperior wall acetabulum fractures. J Orthop Trauma, 2019, 33(Suppl 2): S27-S31.
7. Borg T, Hailer NP. Outcome 5 years after surgical treatment of acetabular fractures: a prospective clinical and radiographic follow-up of 101 patients. Arch Orthop Trauma Surg, 2015, 135(2): 227-233.
8. Ziran BH, Little JE, Kinney RC. The use of a T-plate as “spring plates” for small comminuted posterior wall fragments. J Orthop Trauma, 2011, 25(9): 574-576.
9. Lee AK, Wagner BR, McPhillips K, et al. Locking compression Pilon plate for fixation of comminuted posterior wall acetabular fractures: a novel technique. J Orthop Trauma, 2017, 31(1): e32-e36.
10. Schwab JM, Zebrack J, Schmeling GJ, et al. The use of cervical vertebrae plates for cortical substitution in posterior wall acetabular fractures. J Orthop Trauma, 2011, 25(9): 577-580.
11. Cho JW, Chung HJ, Kim BS, et al. Fragment specific fixation technique using 2.7 mm VA LCP for comminuted posterior wall acetabular fractures: a novel surgical technique. Arch Orthop Trauma Surg, 2019, 139(11): 1587-1597.
12. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
13. Merle-d’Aubigne RM. Reposition with arthroplasty for congenital dislocation of the hip in adults. J Bone Joint Surg (Br), 1952, 34-B(1): 22-29.
14. Firoozabadi R, Hamilton B, Toogood P, et al. Risk factors for conversion to total hip arthroplasty after acetabular fractures involving the posterior wall. J Orthop Trauma, 2018, 32(2): 607-611.
15. Verbeek DO, van der List JP, Tissue CM, et al. Predictors for long-term hip survivorship following acetabular Archives of Orthopaedic and Trauma Surgery fracture surgery: importance of gap compared with step displacement. J Bone Joint Surg (Am), 2018, 100(11): 922-929.
16. Siebenrock KA, Keel MJB, Tannast M, et al. Surgical hip dislocation for exposure of the posterior column. JBJS Essential Surgical Techniques, 2019, 9(1): e2.
17. Sun DH, Zhao Y, Zhang JT, et al. Reconstruction of acetabular posterior wall fractures with extension to the roof using dual arc-shaped plates: A case report. Technol Health Care, 2017, 25(5): 1021-1024.
18. Su K, Liu S, Wu T, et al. Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis. PLoS One, 2017, 12(11): e0187886.
19. 安維軍, 孫建斌, 李志忠. 自制彈簧鋼板在髖臼后壁骨折手術中的應用. 中國修復重建外科雜志, 2020, 34(1): 27-31.
20. Li H, Yang H, Wang D, et al. Fractures of the posterior wall of the acetabulum: treatment using internal fixation of two parallel reconstruction plates. Injury, 2014, 45(4): 709-714.
21. Iselin LD, Wahl P, Studer P, et al. Associated lesions in posterior wall acetabular fractures: not a valid predictor of failure. J Orthop Traumatol, 2013, 14(3): 179-184.
22. Magu NK, Gogna P, Singh A, et al. Long term results after surgical management of posterior wall acetabular fractures. J Orthop Traumatol, 2014, 15(3): 173-179.

Chinese Journal of Reparative and Reconstructive Surgery

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

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