Buttress Plate Research Articles

Posterior wall acetabular fracture fixation: A mechanical analysis of fixation methods.

Stable, anatomical fixation of acetabular fractures gives the best chance of successful outcome, while penetration of the acetabular articular surface with screws is associated with poor outcomes. Spring plates are an alternative to interfragmentary lag screws when penetration is a concern. A mechanical study comparing fracture stability and construct stiffness of three fixation methods for posterior wall acetabular fractures with transverse comminutions was performed. The three fixation methods tested were a posterior wall rim plate, a posterior wall buttress plate with separate lag screws and a posterior wall plate with two spring plates. Nine samples were tested, three for each fixation method. Two-dimensional motion analysis was used to measure fracture fragment displacement and construct stiffness. After two 6000 cycle-loading protocols, to a maximum 1.5 kN, the mean fracture displacement was 0.154 mm for the rim plate model, 0.326 mm for the buttress plate and 0.254 mm for the spring plate model. Mean maximum displacement was significantly less for the rim plate fixation than the buttress plate (p = 0.015) and spring plate fixation (p = 0.02). The rim plate was the stiffest construct 10,962 N/mm, followed by the spring plate model 5637 N/mm and the buttress plate model 4882 N/mm. Based on data obtained in this study, where possible a rim plate with interfragmentary lag screws should be used for isolated posterior wall fractures as this is the stiffest and most stable construct. When this method is not possible, spring plate fixation is a safe and a superior alternative to a posterior buttress plate method.

Competency of distal femur locking plate as an answer for fixation of all varieties of distal femur fractures

<p class="abstract"><strong>Background:</strong> Distal femur fractures are common and need to be treated operatively and for optimal functional outcome. Multiple implants are available for fixation e.g. angled blade plate, dynamic condylar screw, buttress plate, antegrade nailing, retrograde nailing, locking distal femoral plates, external fixator etc. We have designed this study to analyse clinico-radiological outcome and competency of locked plating for all varieties of distal femur fractures.</p><p class="abstract"><strong>Methods:</strong> We conducted a prospective interventional study on 79 consecutive patients with fractures of distal femur operated with locking distal femur plate from January 2015 to February 2018. Patients were regularly followed up with x-rays and clinical examination. At the end of clinicoradiological union, patients were evaluated with Neer’s score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total 79 distal femur fractures were studied based on inclusion and exclusion criteria. There were 63 (79.75%) males and 16 (20.25%) females. As per AO classification fracture of type A were 39 (49.36%), type B were 10 (12.65%) and type C were 30 (37.97%). Average time period from injury to surgery was 8.2 days. In our study, the average period of clinicoradiological union was 16 weeks. 62 (78.48%) patients had excellent to satisfactory outcome, 13 (16.45%) patients had unsatisfactory and 4 (5.06%) patients had poor outcome.</p><p class="abstract"><strong>Conclusions:</strong> Distal femur fractures are common, complex injuries and different implant option are available for fixation. All types of distal femur fractures can be fixed using distal femur locking compression plate. If fixed following basic principles of fracture fixation good results can be obtained.</p>

Good outcome using anatomically pre-formed buttress plates for anteromedial facet fractures of the coronoid-a retrospective study of twenty-four patients.

The aims of this retrospective study were to describe the characteristics of anteromedial facet fracture of the coronoid (AMFF) and to determine the outcome following surgery using anatomically pre-formed coronoid buttress plates. Twenty-four patients underwent surgery for AMFF, using a pre-formed buttress plate, between 2011 and 2017 (20 men, four women), with a mean age of 47.7years (range, 19-78years) and a mean post-operative follow-up of 3.7years (range, 12-86months). Fracture classification, injury pattern, accompanying injuries, post-operative range of motion, and revision rate were noted. Post-operative radiographs assessed union, arthritic change, and joint articulation. Joint function was quantified using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Eleven cases with subtype 2 and 13 cases with a subtype 3 AMFF could be included, of which 15 had an associated rupture of the lateral collateral ligament (LCL) and nine of the medial collateral ligament (MCL). Post-operatively, all cases went to bone union without secondary elbow instability. The mean post-operative range of motion was 125° (range, 90-140°), mean MEPS was 98, mean OES was 43, and mean DASH score was 7. Five patients required repeat surgery within two years due to a limited range of motion; 90% of patients regained their pre-trauma levels of physical activity. AMFF are challenging injuries, frequently associated with lesions to the collateral ligament complex. Using anatomically pre-formed coronoid plates, excellent functional outcomes can be achieved.

Fixation of Posterior Tibial Plateau Fracture with Additional Posterior Plating Improves Early Rehabilitation and Patient Satisfaction.

Introduction:Posterior tibial plateau fractures (PTPF) are difficult to manage because of options of multiple approaches, paucity of implants, and lack of ideal construct for fixation. We investigated the benefits of using posterior approach and buttress plate for fixation of the posterior tibial condylar fractures in terms of the fracture healing rate, clinico-radiological, perioperative morbidity, and patient-related outcomes and compared them in those who achieved acceptable reduction without posterior stabilization.Patients and Methods:Seventy two patients with posterior tibial plateau fractures were prospectively followed after random allocation into two Groups A and B. Thirty eight patients of Group A (dual plating) were managed with stabilization of posterior fragment with Lobenhoffer approach in addition to anterolateral plating. Thirty four patients of Group B (single plate) were managed with isolated anterolateral plating after reducing the PTPF. Twelve patients lost to follow-up and sixty patients were available (thirty in either group) for final assessment. Followup was done by clinical examination, radiographs and computed tomography scan, fracture union, articular continuity, and deformities around the knee. Subjective outcome assessment was done with the International Knee Documentation Committee (IKDC) 2000 and Knee Society Score (KSS).Results:At 1-year followup, the two groups did not differ in time of fracture union. IKDC and KSS were significantly better in dual-plating group (P < 0.001). Mean operative time and blood loss were more in dual-plating group (A). The mean hospital stay and complications did not show significant differences.Conclusion:Addition of posterior approach for stabilization of the posterior fragment in posterior tibial plateau fractures achieves early and improved knee functions, good range of movements, minimal deformities, and pain scores by the time fracture unites. However, peri-operative morbidity, Extra implant costs and increased operative time are its disadvantages.

The “Apple-Bite-Fracture”: ACL rupture combined with posterolateral tibia plateau fracture

Aims and Objectives: Anterior cruciate ligament (ACL) ruptures are often concomitated by posterolateral bone bruise in the MRI. This is caused by a ventral subluxation of the tibia and impact of the femur in the posterolateral tibia plateau. In some cases, this impact causes a fracture of the posterolateral tibia plateau, the so-called Apple-Bite-Fracture. The increased posterior slope can cause additional instability and has to be considered as a risk factor for ACL failure. In this study we investigated the short term clinical outcomes of patients with this combined injury. Materials and Methods: Retrospective study of 14 patients (mean age 46 ± 12,3) (8 male, 6 female) with a mean follow up of 23,75 months. Different treatment strategies were analyzed. The clinical evaluation included visual analog score (VAS) increasing from 0-10 for Pain, IKDC Score, Rasmussen score as well as a clinical evaluation. Results: First analysis of the treatment options revealed a non-uniformed therapy strategy. In three patients the ACL tear was treated nonsurgical. In 11 patients the ACL tear was addressed surgical: six times the ACL was reconstructed with hamstring tendon graft, two times the ACL was sutured. Two patients treated with a non-reconstructive technique to promote healing (“healing response”). In one patient a tibial eminence fracture was fixated with a screw. The fracture of the posterolateral tibia plateau was in nine cases minimally invasive reduced and fixated with a screw osteosynthesis in jail technique. Two patients needed posterior buttress plate. Three times the large bone defect has been augmented with autologous bone graft from the pelvis. The postoperative clinical testing did not reveal any persisting knee instabilities. All patient had a non-limited ROM. No significant differences in ROM in comparison to the contralateral knee was seen. One patient reported persisting knee pain (VAS 3). All other patients reported no pain (VAS 0). Subjective IKDC score was 78,18 (71,3 - 83,9; ± 5,68). Clinical Rasmussen scores ranged from 27 to 30 (mean 27, ± 3,0). Rasmussen radiological results ranged from 16 to 18, mean 16,67 (± 1,15). Conclusion: Despite a very small patient number and leck of statistical power the new patient-spedific mini-metal implant seems to be a good options fort he treatment of middle-aged patients who already underwent frustane cartilage surgery. In these relatively rare caes early unicompartimental arthroplasty can be prevented. Further clinical studies with larger patient collectives have to prove the effectiveness of this new technique.

Precontoured buttress plate vs reconstruction plate for acetabulum posterior wall fractures: A biomechanical study.

BACKGROUNDThe purpose of open reduction and internal fixation of acetabulum posterior wall fractures is to restore anatomical structure and stability of the hip joint, in order to start weight bearing as soon as possible and prevent hip arthrosis; restoration of the anatomy should preserve function of the joint as well. Although “special shaped precontoured plates” have been developed in recent years for surgical treatment of this region, studies comparing the traditional plates with the newly designed precontoured plates are lacking.AIMTo evaluate the biomechanical properties of precontoured anatomic buttress and conventional curved reconstruction plates (CCRPs) for posterior wall acetabulum fracture treatment.METHODSTwelve pelvis models were created for testing plate treatment of fracture in the posterior wall of the acetabulum. These 12 pelvis models were used to create 24 hemipelvis models (experimental) by cutting from the sagittal plane and passing over the center of gravity, after which the posterior wall acetabular fractures (of similar type and size) were created. In these experimental models, the right acetabulum was fixed with a 5-hole CCRP, while the left was fixed with a precontoured anatomic buttress plate (PABP). Samples were placed through the test device and were subjected to static load testing, with a constant testing velocity of 2 mm/min until the load reached 2.3 kN or the acetabular fixation failed. Dynamic tests were also performed with sinusoidal wave load, with a maximal load of 2.3 kN and a load ratio of 0.1.RESULTSThe average stiffness values were 460.83 ± 95.47 N/mm for the PABP and 291.99 ± 118.58 N/mm for the 5-hole CCRP. The precontoured anatomic acetabulum buttress plates had significantly higher rigidity than the CCRPs (P = 0.022). There was a statistically significant difference between the unloaded and 2.3 kN-loaded values of AL (posterosuperior fracture line vertical to the ground surface) and CL (posteroinferior fracture line vertical to the ground surface) parameters for both the PABPs and the 5-hole CCRPs (P = 0.036 and P = 0.045, respectively). According to the static tests, the amount of total displacement was significantly less in the PABPs than in the CCRPs. Comparative analysis of the displacement in the BL (posterior wall fracture line horizontal to the ground) parameter yielded no statistically significant differences between the PABP and the 5-hole CCRPs (P = 0.261).CONCLUSIONPABP provides more stable fixation in acetabulum posterior wall fractures than 5-hole CCRP, allowing for proximal or distal fracture line screw application without reshaping.

The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws

BackgroundThe biomechanical behavior of Pauwels type III fractures should be taken into consideration when performing internal fixation, since this repair should resist the shear force inherent in the vertical fracture line to the greatest extent possible. Recently, the use of a small fragment plate on the medial face of the femoral neck has been proposed by some authors, with satisfactory initial results. In the current study we analyze the mechanical role a medial plate used as a buttress plate for Pauwels type III femoral neck fractures, comparing the resistance of two fixation configurations using three cannulated screws.MethodsPauwels type III fractures were simulated in synthetic bones models and two groups were created, one of those using two parallel screws at the bottom of the femoral neck and the third screw crossing the fracture horizontally (G1), and the other fixed in the same arrangement as G1, but with the addition of a medial side plate at the apex of the fracture (G2).The constructs were subjected to axial loading until catastrophic failure.ResultsThe addition of a medial plate buttressing the femoral neck increased significantly the resistance to maximum loading (p = 0.003).ConclusionUse of a medial buttress plate results in a mechanically superior construction for Pauwels type III fractures fixed with multiple cannulated screws.Lebel of evidence Level IV. Biomechanical comparative study.

The “safe zone” for infrapectineal plate-screw fixation of quadrilateral plate fractures

Extra-articular screw placement in the true pelvis for fixing quadrilateral plate fractures remains challenging. We aimed to define the "safe zone" on the quadrilateral surface to facilitate safe plate-screw placement.Twenty cadaveric hemipelves were sectioned and assembled to define the projection of the acetabular boundary on the quadrilateral surface. Three lines (X, Y, and Z) were drawn tangent to the projection, with X parallel to the iliopectineal line, Y perpendicular to the iliopectineal line, and Z parallel to the posterior border of the ischial body. Then, the distances between X and the iliopectineal line (D1), Y and the sacroiliac joint (D2), and Z and the posterior border of the ischium (D3) could be used to determine a "safe zone" on the quadrilateral surface for screw insertion. We included 15 patients whose conditions satisfied the definition of a comminuted quadrilateral plate fracture and applied two-ended buttress plates for treatment in accordance with this "safe zone."The average D1 was 50.0 mm, the average D2 was 30.6 mm, and the average D3 was 12.4 mm. For all 15 patients with comminuted quadrilateral fracture who were treated, no intraoperative or postoperative screw penetration of the acetabulum was identified, and no loss of reduction was observed during an average follow up of 17.7 months.The "safe zone" established in this study simplifies extraarticular screw placement for managing quadrilateral plate fractures in the true pelvis. As a result, two-ended buttress plate fixation in the true pelvis becomes safe, therefore, treatment with two-ended buttress plates may represent a viable alternative to single-ended elastic fixation in the management of comminuted quadrilateral fractures.

Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach

ObjectiveThe aim of the study is to explore the clinical effect of a dynamic condylar screw (DCS) system, medial anatomical buttress plate (MABP), and autogenous iliac bone graft through the Watson-Jones approach in the treatment of femoral neck nonunion. MethodsThis prospective study included 15 patients (12 men and 3 women) with nonunion of femoral neck fracture, who were treated with the DCS and MABP with autogenous iliac bone graft through the Watson-Jones approach. The patients were followed up for an average of 16 months (range, 12–24 months). ResultsAll patients achieved bone healing with an average fracture healing time of 3.4 months (2.8–4.6 months). The Harris score significantly increased from 30 ± 3.9 before the operation to 87.6 ± 7.9 at the last follow-up, and the visual analogue scale significantly decreased from 4 ± 1.3 before the operation to 1 ± 1.7 at the last follow-up. The average limb shortening was reduced from 1.8 cm (range, 0–3.1 cm) before the revision operation to 0.5 cm (range, 0.1–1.3 cm) after the last follow-up. The neck-shaft angle of the injured side was restored from an average of 118° (range, 108–139°) before the revision operation to an average of 132° (range, 127–144°) at the last follow-up. No collapse of the femoral head, wound infections, screw backout, screw or plate breakages, or nerve injury was found. ConclusionTheDCS and MABP with autogenous iliac bone graft through the Watson-Jones approach is an effective option for the treatment of femoral neck nonunion or delayed healing. The translational potential of the articleThis article shows that the application of DCS and MABP provides a rigid fixation at the fracture site to promote bone graft integration and bone union. This new kind of technique could be one option of Hip conservation procedures, just special for young patients with femoral neck nonunion.

Advances in selection of surgical approach and internal fixation for posterolateral tibial plateau fractures

There haven't been an uniform criterion for the treatment of posterolateral tibial plateau fracture till now. For this type of fractures, surgical approaches are divided into two main parts, non-osteotomy approach and osteotomy approach. The non-osteotomy approach includes posterolateral approach, anterolateral approach, lateral approach, posteromedial approach and posterior approach. Each of them includes advantage and disadvantage. Posterolateral approach is the most effective exposure of posterolateral tibial plateau fracture. Satisfactory reduction and buttress fixation could be achieved under direct view. Posterolateral tibial plateau fracture could also be exposed from the gap between fibular head and posterolateral tibial plateau via anterolateral approach, but the raft plate should be placed backwardly to achieve the best fixation result. With a single lateral incision of the tibial plateau, the anterolateral and posterolateral plateau fragments could be fixed simultaneously through the anterolateral and posterolateral interval of the deep tissue. The anatomy of the posteromedial approach is simpler, however, it's difficult to view all the comminuted fragments of the posterolateral tibial plateau. The injury risk of popliteal blood vessels and nerves is relatively high, therefore it's rarely used right now. The osteotomy approach includes fibular head, lateral femoral epicondyle and tibial Gerdy tuberosity osteotomy. The osteotomy approaches of lateral femoral epicondyle and tibial Gerdy tuberosity are usually used in the cases associated with the anterolateral approach of the knee. The best view of the posterolateral tibial plateau could be obtained via the fibular head osteotomy approach. But the extra damage is too severe to recommend routinely. On the other hand, there are several fixation options when posterolateral tibial plateau fractures are treated. The buttress plate was verified to be the best fixation method and the rim plating provided a novel idea for this fracture pattern. The fibular support is a reliable method for posterolateral compression fracture as well. We will summarize the selection of surgical approaches and internal fixation methods to provide a reference for the clinical doctors. Key words: Tibial plateau; Posterolateral; Surgical approach; Osteotomy; Fracture fixation, internal

Outcome of the surgical management of single versus comminuted fractures of the posterior wall of the acetabulum

Introduction- Posterior wall fractures of the acetabulum account for 1/3rd of all acetabulum fractures. The comminuted fractures managed surgically have poor outcomes in 30% patients even after anatomical reduction and fixation. The choice of fixation, anatomical reduction and stable fixation are important for better outcomes. Materials And Methods- A total of 27 patients with a minimum age of 18 years were included in the study and managed surgically by fixation by buttress plates and screws in all patients by the Kocher Langenback approach. They were followed up for a minimum follow up of 1 year for their clinical and radiological outcomes. The outcome was assessed at the final follow up as per the Merle de’Aubigne score. Results- The post-operative reduction was anatomical in 18 patients, good in 7 and poor in 2. The clinical outcome as per the modified Merle de’Aubigne score at the final follow up was found to be excellent in 12 (44.4%), good in 8 (29.6%), fair in 3 (11.1%) and poor in 4 (14.8%). The radiological outcome was evaluated as per Matta’s criteria and was found to be excellent in 13 (48.1%), good in 5 (18.5%), fair in 4 (14.8%) and poor in 5 (18.5%). Conclusion- Supplementing the screw fixation of the posterior wall by plates allow for early mobilization of the patients leads to more favorable results in isolated single posterior wall fragment as compared to comminuted posterior wall fragment.

Functional outcome of 59 patients of bicondylar tibial plateau fractures treated with internal vs external fixation: Selection criteria

Background: The purpose of this prospective study was to evaluate the Functional results of Internal versus External fixation of bicondylar tibial plateau fractures decided on specific selection criteria.Materials and Methods: Fifty nine patients with tibial condyle fractures (Schatzker type V and VI) were recruited in the study between Nov 2013 and Dec 2015 at our tertiary care hospital in Bengaluru, India. Open reduction and internal fixation with Dual Buttress plates, Buttress plate and CC screws was done in 38 patients (closed, Type I & II open with good skin conditions). Hybrid External fixation was done in 21 patients (closed, Type I & II open with bad skin conditions, Impending compartment syndrome). They were followed up at six weeks, six months and twelve months and was evaluated for the functional outcomes by Hospital for special surgery knee scoring system (HSS). Result: 86% of our patients had good to Excellent results according to HSS score. The outcomes between both modes of fixation were not significantly different at 1 year follow up. There was no difference in total arc of knee motion. Mean range of knee flexion in internal fixation was 115.79 + 21.290, External fixation was 115.24 + 13.370. Average HSS Score at final follow up for internal fixation was 78.87 + 10.94 and external fixation was 78.71 + 9.05. 2 patients needed flap surgery due to wound complications, 3 patients experienced infection following internal fixation compared to external fixator. 1 patient experienced non union following external fixation.Conclusion: Both methods of fixation in Bicondylar tibial plateau fractures gives a favourable functional outcome provided selection criteria is followed strictly. Level of Evidence: Level 3.

Various methods of surgical management and its utility in proximal humerus fractures: A prospective study of 30 cases

Background: Treatment of fractures of proximal humerus has been a subject of much controversy and confusion with diversity of opinion regarding the management of fractures of proximal end of humerus. The aim of this study was to know the best modality of management of proximal humerus fracture in a defined patient group by reviewing the outcome, results and complications of the various operative procedures for fixation of proximal humerus fracture and their comparison in a series of thirty patients. METHODS: Over a two-year period, we treated thirty patients of two-part fractures and three-part fractures, with percutaneous pinning with K-wires, cancellous screws, buttress plate (T/Clover leaf), and LCP. All patients underwent rigorous postoperative rehabilitation under the supervision of physiotherapist and functional outcome was assessed with the use of Neer’s shoulder score. RESULTS: All fractures united within the first year and 1 patient had pin infection, 1 had loss of reduction, 3 cases malunion, 2 impingement and 1 case of AVN. The functional outcome of the assessment performed with Neer’s score 57% of the cases had excellent results, 20% satisfactory results, 16% of them had unsatisfactory results and failure was seen in 7% of the cases. CONCLUSION: ORIF in adult patients with proximal humeral fractures reduces hospital-stay thereby preventing loss of earning and in elderly patients prevents reflex sympathetic dystrophy, stiffness and shoulder hand syndrome by early mobilization without any undue risk of loss of fixation and reduction.

Management of distal femur fractures with bicolumnar fixation with condylar buttress plate and TENS nail

Introduction: The fracture of distal femur are often unstable and comminuted and as difficult to treat. The incidence of complications in these fracture are relatively high. We have treated the fracture of distal femur with comminuted medial wall with condylar buttress plate and support of medial wall with TENS nail.Material and Methods: Fifty three patients with intercondylar fracture of distal femur were selected. There were thirty three males and twenty females. The average age of the patients was 36.2 years. All the patients were operated between 3 to 7 days. The final outcome was assessed according to schatzker and Lambert scoring system. The complications were also noted.Results: The result was excellent in fifteen, good in twenty three, fair in eleven and poor in four patients according to schatzker and Lambert scoring system. The average time to Union was 14.2 weeks. Complications include superficial wound infection in five patient, knee stiffness, and varus angulation less than 5 degree in eight and five patients respectively.Conclusion: The use of TENS nail for medial femoral defect along with condylar buttress plate may eliminate the need of plate on medial side. The varus angulation that occurs with defect is decreased and additional long incision and operative time is avoided.

Volar Buttress Plating for Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint With a Central Depressed Fragment: A Preliminary Report of 12 Cases

A preliminary report is presented of 12 patients with dorsal fracture-dislocations of the proximal interphalangeal joint with a central depressed fragment treated by volar buttress plating, with good results.

Vascular Anatomy of the Medial Femoral Neck and Implications for Surface Plate Fixation.

To describe the inferior retinacular artery (IRA) as encountered from an anterior approach, to define its intraarticular position, and to define a safe zone for buttress plate fixation of femoral neck fractures. Thirty hips (15 fresh cadavers) were dissected through an anterior (Modified Smith-Petersen) approach after common femoral artery injection (India ink, blue latex). The origin of the IRA from the medial femoral circumflex artery and the course to its terminus were dissected. The IRA position relative to the femoral neck was described using a clock-face system: 12:00 cephalad, 3:00 anterior, 6:00 caudad, and 9:00 posterior. The IRA originated from the medial femoral circumflex artery and traveled within the Weitbrecht ligament in all hips. The IRA positions were 7:00 (n = 13), 7:30 (n = 15), and 8:00 (n = 2). The IRA was 0:30 anterior to (n = 24) or at the same clock-face position (n = 6) as the lesser trochanter. The mean intraarticular length was 20.4 mm (range 11-65, SD 9.1), and the mean extraarticular length was 20.5 mm (range 12-31, SD 5.1). The intraarticular course of the IRA lies within the Weitbrecht ligament between the femoral neck clock-face positions of 7:00 and 8:00. A medial buttress plate positioned at 6:00 along the femoral neck is anterior to the location of the IRA and does not endanger the blood supply of the femoral head. The improved understanding of the IRA course will facilitate preservation during intraarticular approaches to the femoral neck and head.

Assessment of Efficacy of Supraintercondylar and Supracondylar Femur Fractures Treated with Condylar Buttress Plates: A Comparative Study

Assessment of Efficacy of Supraintercondylar and Supracondylar Femur Fractures Treated with Condylar Buttress Plates: A Comparative Study

Supplemental Superior Buttress Plating for the Treatment of Posterosuperior Wall Acetabulum Fractures

Posterosuperior wall acetabulum fractures are a unique and uncommon fracture pattern. Traditional plate fixation may not provide adequate fixation of these fracture fragments. This article presents a surgical technique and the results of a case series using a supplemental 1/3 tubular superior buttress plate to improve fracture reduction and better neutralize shear forces in the treatment of superior posterior wall fractures. Additionally, we compared failure rates of those posterior superior wall acetabular fractures treated with supplemental superior buttress plates to those treated with standard plate fixation and no supplemental superior buttress plates.

Outcomes of Surgical Treatment of Periprosthetic Acetabular Fractures.

Periprosthetic acetabular fractures sustained following acute trauma after total hip arthroplasty are rare and historically have poor outcomes. This article reviews 5 cases and the treatment algorithm used by a single orthopaedic surgeon specializing in acetabular fracture care with a co-surgeon specializing in arthroplasty. Team-based surgical management with arthroplasty- and fracture-trained surgeon(s) is paramount for optimal outcome. The following approach resulted in satisfactory outcomes without need for revision implants. In fracture patterns with columnar involvement, the columns were restored with plates and screws. In fracture patterns with wall involvement, the acetabular component functioned as a template for wall reconstruction with use of a buttress plate. The acetabular component was revised when deemed loose during stress of the component through the surgical approach used for fracture fixation.

Screw fixation of ACPHT acetabular fractures offers sufficient biomechanical stability when compared to standard buttress plate fixation

BackgroundGeriatric acetabular fractures require fixation with sufficient primary stability to allow for immediate full-weight bearing. Minimally-invasive procedures would be desirable in order to keep perioperative morbidity low. The purpose of this study was to compare the biomechanical strength of lag screw-only fixation of anterior column posterior hemi-transverse (ACPHT) acetabular fractures to standard anatomical plate fixation.MethodsStandardized ACPHT fractures were created in fourth generation synthetic pelvis models and stabilized by either an anatomical buttress plate (n = 4) or by a screw-only construct (n = 4). In a validated setup, a cyclic loading protocol was applied with increasing axial force (3200 cycles, 175 N to 2250 N). Construct survival, acetabular fracture motion, and mode of failure were assessed.ResultsThe median number of cycles needed until failure of the construct occurred was 2304 cycles (range, 2020 to 2675) in the plate fixation group and 3200 cycles (range, 3101 to 3200) for the screw fixation constructs (p = .003). With regard to energy absorbed until failure, the plate fixation group resisted to 1.57 × 106 N*cycles (range, 1.21 × 106 to 2.14 × 106) and the screw fixation group to 3.17 × 106 N*cycles (range, 2.92 × 106 to 3.17 × 106; p = .001). All plate fixation specimens failed with a break-out of the posterior-column screw in the quadrilateral wing of the anatomical plate within a maximum load of 1750 N while the screw fixation constructs all survived loading of at least 2100 N. Acetabular fracture gap motion, acetabular rim angle, and medial femoral head subluxation as measures of fracture displacement were all not different between the two groups (p > 0.1).ConclusionsIn this in vitro biomechanical study, screw-only fixation of an ACPHT acetabular fracture resulted in at least as good construct survival as seen for standard buttress plate fixation. Both methods resisted sufficiently to forces that would be expected under physiologic conditions.