Application of customized variable-angle locking acetabular wing plates in treatment of acetabular fractures in the elderly via the lateral-rectus approach

Abstract

Objective To evaluate clinical efficacy and surgical techniques of customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly through the lateral-rectus approach. Methods Data of 11 elder patients of complex acetabular fractures (mean age 75 y, range: 60-93 y; 8 males, 3 females) admitted to our department from March 2016 to March 2017 were retrospectively analyzed. According to Judet-Letournel classification of acetabular fractures, there were 2 cases of anterior column and posterior hemitransverse fractures, 9 cases of both-column fractures. The customized variable-angle locking acetabular wing plates were designed by mimics software and then produced before surgery. During the operation, the customized variable-angle locking acetabular wing plate was applied to reduction and fixation via the anterior lataral-rectus approach. The effect of fracture reduction was assessed by Matta's criteria. The clinical effect was assessed by Harris Hip score and the modified Merle d' Aubigne-Postal score at the 6th month of postoperative follow-up. Results The average time of designing and producing customized variable-angle locking acetabular wing plates was 4 d (3-5 d), the average operation time was 95 min (45-150 min), and the average intraoperative bleeding was 600 ml (250-1 400 ml). All patients were followed up, with an average follow-up of 18 m (6-24 m). All fractures were healed, with an average healing time of 8 weeks (6-12 weeks). Reduction quality: excellent in 8 cases, good in 2 cases, poor in 1 case, with an overall excellent and good rate of 90.9%. The result of Harris Hip scoring: excellent in 7 cases, good in 3 cases, and acceptable in 1 case, with a total excellent and good rate of 90.9%; Modified Merle d' Aubigne-Postal soring: excellent in 6 cases, good in 3 cases, and acceptable in 2 cases, with an overall excellent and good rate of 81.8%. There were 2 cases of obturator nerve injury, 1 case of fat liquefaction of incision, 3 cases of traumatic hip arthritis. During the follow-up, no complications such as ectopic ossification, plate fracture and screw loosening were found. Conclusion The customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly via the lateral-rectus approach can achieve satisfactory reduction and firm fixtation. Key words: Acetabulum; Fracture; Aged; Fracture fixation, internal