The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate

Maximilian J. Hartel,Florian Fensky,Karl-Heinz Frosch,Wolfgang Lehmann,Darius M. Thiesen,Dimitris Ntalos,Frank O. Henes,Tareq Naji

doi:10.1007/s00402-021-03867-3

Abstract

PurposeTo investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures.Patients and methodsA consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography.ResultsMost frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty.ConclusionA preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.

Highlights

In recent years, acetabular fractures have shown an increasing incidence, in the elderly
Several poor prognostic factors for open reduction and internal fixation (ORIF) in the elderly have been described such as posterior wall comminution, marginal impaction, femoral head impaction or hip dislocation
The direct anterior approach (DAA) utilizing the Smith Petersen interval was used in the following four cases: In three periprosthetic fracture cases, plate osteosynthesis was performed from the inside through the AIP and revision arthroplasty was performed from outside using the DAA

Summary

Introduction

Acetabular fractures have shown an increasing incidence, in the elderly. As opposed to younger individuals, they are commonly the result of a low-impact trauma and lead to poorer radiological and clinical outcome. Anatomical reduction and its retention are the main goals of the surgical treatment of unstable acetabular fractures [1,2,3,4,5]. Several poor prognostic factors for open reduction and internal fixation (ORIF) in the elderly have been described such as posterior wall comminution, marginal impaction, femoral head impaction or hip dislocation. Total hip arthroplasty (THA) provides an additional treatment option in elderly patients with the rate of conversion to THA following ORIF reported to be approximately 20–25% [2,3,4, 6, 7].

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Conclusion