Role of combined brim and spring plates in the treatment of acetabular fractures involving quadrilateral plates: a retrospective study of early results

Abstract

Background: Quadrilateral plate (QP) fractures constitute an intrapelvic component of acetabular fractures and are challenging for surgical fixation. Inability to reduce and buttress QP leads to poor functional outcome. The hypothesis was that use of combined brim and spring plates for fixation of fractures that involved QP would maintain reduction and improve functional outcomes of those patients. Methods: This was a retrospective case series study of 44 patients with acetabular fractures that involved QPs that were fixed by combined brim and spring plates between March 2015 and January 2020 in the orthopaedic surgery department in Suez Canal University Hospitals. All patients were operated by the same surgical team. A minimum of 12 mo of postoperative follow-up was planned for each. Statistical analysis was done using SPSS software (version 17 for Windows, Chicago, Illinois). Results: The mean patient age was about 40.4 yr. The associated dislocations were present in ten patients (22.7%). Anterior column and posterior hemitransverse fractures were in about 50% of patients. Average operative time was about 146 min. Average intraoperative blood loss was about 583 mL. No patients developed avascular necrosis of the femoral head, heterotopic ossification, or implant failure. Two patients had postoperative obturator nerve injury. Quadrilateral component reduction was anatomical in 28 hips (63.6%). At 1-year follow-up, final clinical scores were excellent in 15 hips (34.1%) and good in 18 hips (40.9%). Conclusions: Combined brim and spring plates can maintain anatomical reduction of QP fractures and give good clinical results with less operative time and fewer complications than other methods mentioned in the literature. Level of Evidence: Level IV.