Treatment of complex quadrilateral fractures of the acetabulum with anterior reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws

Abstract

Objective To summarize our clinical experience in the treatment of complex quadrilateral fractures of the acetabulum with anterior reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws.Methods From March 2010 to January 2013,21 cases of quadrilateral fractures of the acetabulum were treated in our department.They were 13 males and 8 females,aged from 19 to 65 years (average,41.2 years).According to the Letournel classification,there were 11 double-column fractures,5 T-shaped ones and 5 anterior column plus posterior hemi-transverse ones.The average time from injury to operation was 6.5 days (from 4 to 16 days).All cases were treated via the ilioinguinal approach with internal fixation with reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws.Results The operation time for this series ranged from 120 to 270 minutes,averaging 190 minutes.The intraoperative blood bleeding ranged from 300 to 1 800 mL,with an average of 540 mL.By the modified Matta evaluation system,14 cases had anatomic reduction,6 cases satisfactory reduction,and one dissatisfactory reduction.The 21 patients were followed up from 6 to 38 months (average,21.4 months).According to the improved Merled' Aubigne-Postel criteria at the last follow-up,12 cases were rated as excellent,5 good,fair 3 cases,and one poor,giving an excellent-to-good rate of 81.0 ％.The complication rate for this series was 23.8％ (5/21),including 2 cases of lateral femoral cutaneous nerve injury,one case of heterotopic ossification and 2 cases of traumatic arthritis.Conclusion In the treatment of quadrilateral fractures of double columns,T-shaped fractures and anterior column plus posterior hemi-transverse fractures,internal fixation with anterior reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws is really an optimal choice,because it can lead to limited invasion,rigid fixation,fewer complications,and satisfactory outcomes. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone nails; Bone plates