Transverse Acetabular Fractures Research Articles

Transformation of transverse fractures of the acetabulum in T-shaped fractures and sequential approaches

Transverse acetabular fractures are difficult to reduce and generally associated with poorer clinical outcomes than other types of acetabular fractures. For these fractures affecting both columns, the surgical strategy is subject to controversy and there is currently no optimal method of management. The transformation of these transverse fractures in to a T-shaped fracture makes it possible to make the anterior and posterior components of the fracture independent and to reduce them sequentially. This technique has made it possible to obtain a satisfactory reduction of the fracture in certain cases and gives hope for good long-term functional results. Level of evidenceIV.

Predictors for post-traumatic hip osteoarthritis in patients with transverse acetabular fractures following open reduction internal fixation: a minimum of 2 years’ follow-up multicenter study

BackgroundThe predictors of post-traumatic osteoarthritis (PTOA) in patients with transverse acetabular fractures (TAFs) following open reduction internal fixation (ORIF) remain unclear. This study aimed to investigate the risk factors for PTOA in TAFs after ORIF.MethodsData of TAF patients receiving ORIF were collected from January 2012 and February 2021. Patients suffered PTOA were classified as the osteoarthritis group (OG), while those without PTOA were classified as the non- osteoarthritis group (NG) with a minimum follow-up of 2 years. PTOA was diagnosed according to Tönnis OA classification during the period of follow-up. Univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analyses were used to evaluate demographics, injury-related characteristics, perioperative and post-discharge information.ResultsThree hundred and eleven TAF patients were analyzed in this study, including 261 males and 50 females, with a mean age of 40.4 years (range 18 to 64 years). The incidence of PTOA was 29.6% (92 of 311) during the mean follow-up of 36.8 months (range 24 to 70 months). Several factors of PTOA were found using univariate analysis, including transverse fracture associated with posterior wall acetabular fracture (TPW-AF, p = 0.002), acetabular roof fracture (ARF, p = 0.001), femoral head lesion (FHL, p = 0.016), longer time from injury to surgery (TIS, p＜0.001) and physical work after surgery (PWAS, p＜0.001). Logistic regression analysis showed that TPW-AF (p = 0.007, OR = 2.610, 95%CI: 1.302–5.232), ARF (p = 0.001, OR = 2.887, 95%CI: 1.512–5.512), FHL (p = 0.005, OR = 2.302, 95%CI: 1.283–4.131), TIS (p<0.0001, OR = 1.294, 95%CI: 1.192–1.405) and PWAS (p<0.0001, 3.198, 95%CI: 1.765–5.797) were independent risk factors of PTOA. Furthermore, ROC curve analysis indicated 11.5 days as the cut-off values to predict PTOA.ConclusionsOur findings identified that TPW-AF, ARF, FHL, TIS and PWAS were independent risk factors for PTOA in patients with TAFs following ORIF. It can help orthopedic surgeons to take early individualized interventions to reduce its incidence.

Clinical outcomes of percutaneous screw fixation of acetabular fracture: A minimally invasive procedure

ObjectiveOpen reduction with internal fixation is the surgical intervention of choice for acetabular fractures (AFs). Percutaneous screw fixation for AFs is a new procedure that is desirable because of the complex anatomy of the pelvis. In this study, we aimed to assess the functional outcomes, mobility, healing, and distal neurovascular abnormalities in patients who underwent percutaneous retrograde screw fixation. MethodsOur study included 36 patients with AFs treated with percutaneous screw fixation between January 2016 and June 2021. There were 18 cases with anterior column AF, 7 cases with transverse AF, and 11 cases with associated AF, 6 of which had a T-shaped AF. Frequencies and percentages were used to describe characteristics and clinical outcomes. Mean and standard deviation were used for continuous variables. SPSS version 23 (IBM Corporation, Armonk, NY, USA) was used for statistical analysis. ResultsThe average time to regain full mobility with full weight bearing was 12.9 ± 5.4 weeks, and approximately 11.1 ± 2.8 weeks was required for patients to be pain-free with satisfactory fracture healing. Only a minority (8.3%) of patients had abnormalities affecting the distal neurovascular system, and 11.1% experienced sexual dysfunction. Pain severity was assessed with a visual analogue scale. The average pain severity on the first and third post-operative days was 4 ± 2.4 and 3.8 ± 2.6, respectively. However, the average pain intensity before discharge was 1.7 ± 2.6. ConclusionPercutaneous screw fixation is the most efficient surgical choice for most pelvic/AFs.

Three-dimensional mapping study of pure transverse acetabular fractures

BackgroundTo describe and analyze the morphological characteristics, location and frequency of pure transverse acetabular fracture lines through fracture mapping and quantitative measurements.MethodsTransverse fractures were retrospectively reviewed and analyzed. All computed tomography (CT) data were used for reconstruction and manual reduction. The reductive fracture fragments were graphically overlaid onto a three-dimensional (3D) right hemipelvis template. Then, the fracture lines were accurately depicted onto the surface of the 3D template. The fracture lines were overlapped onto the model to create the 3D fracture map and heatmap. All cases were subdivided into infratectal (62-B1.1), juxtatectal (62-B1.2), and transtectal (62-B1.3) types based on the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification. Some anatomic parameters of the transverse fractures were also analyzed in these 3 groups.ResultsOur study included forty-nine transverse fractures from 32 male and 17 female patients (mean age, 42 years; range 21–74 years) and included 19 type 62-B1.1, 17 type 62-B1.2, and 13 type 62-B1.3 fractures. The average anterior rim fracture angle was 70.0° (± 11.6°), and the posterior rim fracture angle was 92.4° (± 28.5°). The anterior rim fracture angles in 40 cases (40/49, 81.6%) fell within a wide range between 63° and 80°. On the heatmap, the hot zones were located on the highest position of the cotyloid fossa and the narrowed region, and the cold zone was on the inferior third of the articular surface. For type 62-B1.3 fractures, the hot zone was located on the posterior of the acetabular dome. There were no significant differences in anterior rim fracture angle and anterior height among the three patterns (P = 0.071, P = 0.072). Post hoc tests of the posterior rim fracture angle and the posterior height revealed significant differences among fracture subtypes (P < 0.01). The posterior intra-articular fracture line was significantly longer than the anterior intra-articular fracture line in type 62-B1.1 and type 62-B1.2 fractures (P < 0.01).ConclusionThe fracture lines of transverse fractures through the anterior rim were concentrated on the narrowed zone, and the posterior fracture lines were diffusely distributed. The intra-articular fracture line distribution was focused on the superior and middle thirds of the joint surface. The recurrent fracture lines involving the weight-bearing dome mainly converged on the posterior region of the roof.

The survivorship and factors affecting the outcome of the use of spring plates in multifragmentary posterior wall acetabular fractures at a single academic institution.

Multifragmentary posterior wall fractures are not uncommon after posterior hip fracture-dislocation. They can be elementary but are commonly associated with transverse acetabular fractures. Specific technical challenges are encountered when managing these fracture patterns. The loss of the posterior landmarks due to the associated comminution may render achieving an anatomical reduction and stable fixation difficult. The application of spring plates can provide a good buttress with multiple anchor points and creates a new cortex for the bridging plate. -To assess the outcome and survivorship of the use of spring plates for the fixation of multi-fragmentary posterior wall fractures. -To analyse the factors affecting the outcome of the fixation of these challenging injuries. We retrospectively reviewed all the patients who underwent posterior wall acetabular fixation using a spring plate between December 2009 and March 2020 at our institution. Forty-seven patients had a minimum follow-up of 1year and were included in the study with a mean age of 36 ± 10years (range:17-60) and a mean follow-up period of 4.4 ± 3.5years. Seventeen patients had an associated transverse acetabular fracture, and an anterior columnar screw was used for additional fixation. Functional outcome was assessed using the Oxford hip score (OHS). Radiological assessment was undertaken for the images done immediately post-operatively and at the last follow-up. Patients with advanced post-traumatic arthritis and complications such as avascular necrosis (AVN), nerve injuries, non-union, heterotopic ossification and fixation failure were identified. The hazard rate of re-operation on the native hip was estimated using the life tables. Kaplan Meier analysis was used to assess survival with THR or excision arthroplasty as an endpoint. Six patients underwent a total hip replacement: secondary to AVN in four and infection in two patients. The hazard of THR was estimated at 6% (SE = 0.02) during the first three years, then decreased dramatically afterwards. The five-year survival of native hip was 83% (SE = 0.06). Native hip was expected to survive for 10.67years (95% CI 9.49-11.83) without joint replacement. The mean OHS in our cohort was 33.66 (3-48), and 29 patients (61.70%) had an OHS of more than 30. The use of spring plates to fix multifragmentary posterior wall fractures has excellent mid-term results, high survivorship and a low complication rate. Combining an anterior columnar screw and a posterior spring plate has shown to be a suitable fixation construct in selected patients with associated transverse acetabular fractures. A longer-term follow-up with a larger cohort using this fixation construct is needed.

The use of a 3D-printed personalised drill guide for posterior column lag screw fixation in displaced transverse acetabular fracture: A case report.

Introduction and importanceAnterior column plate combined with posterior column screws have been effectively used for treatment of displaced transverse acetabular fractures. This article presents the use of 3D-printed technology for customising a guide template to appropriately place posterior column screw.Case presentationA 50-year-old female suffered displaced juxtatectal fracture of the right acetabulum. A personalised guide for antegrade posterior column screw placement was designed based on the data of her pelvic CT-scan. This guide and a prototype of her right acetabulum - created by mirroring the intact left acetabulum - were 3D-printed for preoperative evaluation and pre-contouring of reconstruction plate. Modified Stoppa approach and additional lateral window were used for direct reduction, anterior column plate and posterior column lag screw fixation. Post-operative CT-scan showed good reduction and nearly ideal screw position.Clinical discussionAnterior column plate and antegrade posterior column screw could provide joint stability and early mobilisation for displaced transverse acetabular fractures. However, determination of optimal entry point, direction and length for screw insertion is still technically demanding. The 3-D reconstruction images of hemipelvic specimen allowed us to identify the safe bone corridor, design a drill guide to put the proper guide pin and conduct preoperative trial. All those resulted in appropriate real screw fixation with reduction of soft tissue damage, X-ray exposure and time of operation.ConclusionThe use of 3D-printed personalised guide for posterior column screw fixation is a promising alternative option for treatment of displaced transverse acetabular fracture where 3D-navigation system is not available.

高齢者のけいれん発作に合併した非外傷性寛骨臼骨折の1例(Nontraumatic acetabular fracture associated with convulsive seizure in an older patient: a case report)

要旨 新規発症けいれん発作の約50%が高齢者であり，救急医療において診療する機会が増加すると考えられる症候である。寛骨臼骨折は高エネルギー外傷により起こることが多く，けいれん発作に伴い生じることはあまり知られていない。今回，80歳代の男性がけいれん発作を契機に二次的外傷を伴うことなく寛骨臼骨折を合併した。CTでは，骨折とともに造影剤血管外漏出所見を認め，経カテーテル動脈塞栓術による止血を行った。けいれんに伴う骨折は，発作後の意識障害により診断が遅れ，活動性出血を伴う症例では致命的となりうる。けいれん発作は非外傷性骨折の原因となり，寛骨臼骨折は見逃してはならない合併症であるとともに，止血介入を要する可能性があるとの認識を要するものと思われる。

Surgical outcomes of transverse acetabular fractures and risk factors for poor outcomes

BackgroundTransverse acetabular fractures, although classified as elementary, have worse outcomes than other types of acetabular fractures. Prognostic factors for this fracture type are not clearly established. This study aimed to assess the surgical outcomes of transverse acetabular fractures and subtypes thereof and to investigate the prognostic factors.MethodsBetween 2014 and 2019, 39 patients (39 hips) had transverse fractures or subtypes thereof. We reviewed the surgical outcomes and evaluated patient factors, injury factors, and surgical factors in relation to osteoarthritis (OA) and conversion to total hip arthroplasty (THA). Additionally, we analyzed the cutoff values for postoperative residual gaps and steps.ResultsTwenty-three male patients and sixteen female with a mean age of 41.7 years (range, 18–78 years) were included. There were 29 satisfactory reductions (74.4%). Eleven hips (28.2%) developed OA, and five (12.8%) of them underwent THA. Dome impaction (odds ratio [OR], 41.173; 95% confidence interval [CI], 1.804–939.814; p = 0.020) and residual gaps (OR, 4.251; 95% CI, 1.248–14.479; p = 0.021) were correlated with poor outcomes. Residual gaps (≥3 mm) and residual steps (≥1 mm) were significantly associated with OA.ConclusionsRelatively poor reduction was found for transverse acetabular fractures and subtypes thereof. However, the rates of OA and conversion to THA were not high. Dome impaction and wide residual gaps were identified as risk factors for poor outcomes. The development of OA significantly increased if residual gap and step were more than 3 mm and 1 mm, respectively.

Latent Superior Gluteal Artery Injury by Entrapment between the Fragments in Transverse Acetabular Fracture: A Case Report

Latent Superior Gluteal Artery Injury by Entrapment between the Fragments in Transverse Acetabular Fracture: A Case Report

Biomechanical analysis of transverse acetabular fracture fixation in the elderly via the posterior versus the anterior approach with and without a total hip arthroplasty.

This study provides the first biomechanical comparison of the fixation constructs that can be created to treat transverse acetabular fractures when using the "gold-standard" posterior versus the anterior approach with and without a total hip arthroplasty in the elderly. Synthetic hemipelvises partially simulating osteoporosis (n = 24) were osteotomized to create a transverse acetabular fracture and then repaired using plates/screws, lag screws, and total hip arthroplasty acetabular components in one of four ways: posterior approach (n = 6), posterior approach plus a total hip arthroplasty acetabular component (n = 6), anterior approach (n = 6), and anterior approach plus a total hip arthroplasty acetabular component (n = 6). All specimens were biomechanically tested. No differences existed between groups for stiffness (range, 324.6-387.3 N/mm, p = 0.629), clinical failure load at 5 mm of femoral head displacement (range, 1630.1-2203.9 N, p = 0.072), or interfragmentary gapping (range, 0.67-1.33 mm, p = 0.359). Adding a total hip arthroplasty acetabular component increased ultimate mechanical failure load for posterior (2904.4 vs. 3652.3 N, p = 0.005) and anterior (3204.9 vs. 4396.0 N, p = 0.000) approaches. Adding a total hip arthroplasty acetabular component also substantially reduced interfragmentary sliding for posterior (3.08 vs. 0.50 mm, p = 0.002) and anterior (2.17 vs. 0.29 mm, p = 0.024) approaches. Consequently, the anterior approach with a total hip arthroplasty may provide the best biomechanical stability for elderly patients, since this fixation group had the highest mechanical failure load and least interfragmentary sliding, while providing equivalent stiffness, clinical failure load, and gapping compared to other surgical options.

Biomechanical comparison of fixation techniques for transverse acetabular fractures – Single-leg stance vs. sit-to-stand loading

ObjectivesTo biomechanically compare five different fixation techniques for transverse acetabular fractures using both the single-leg stance (SLS) and the sit-to-stand (STS) loading protocols and to directly compare fracture gap motion (FGM) and relative interfragmentary rotation (RIFR). MethodsTranstectal transverse acetabular fractures were created on fourth-generation composite hemipelves in a reproducible manner. Five different fixation techniques were biomechanically assessed using both an SLS and STS loading protocol: anterior plate (AP) only, posterior plate (PP) only, anterior plate plus posterior column screw (AP+PCS), posterior plate plus anterior column screw (PP+ACS) and anterior plus posterior plate (AP+PP). After preconditioning, the specimens were loaded from 50 to 750 N with a ramp of 100 N/s. FGM and RIFR under loads of 750 N were measured using an optical 3D measurement system. ResultsIn the three groups of fixation techniques addressing both columns, STS loading resulted in higher mean FGM and in RIFR than SLS loading. No construct failure was observed. In the single plate groups (AP only and PP only), STS loading resulted in failure of all specimens before reaching loads of 750 N, while no failure occurred after SLS loading. No significant differences in FGM and RIFR were found between the double plate (AP+PP) and the single plate plus column screw (AP+PCS and PP+ACS) techniques. ConclusionSLS loading appeared to overestimate the strength of acetabular fracture fixation constructs and STS loading may be more appropriate to provide clinically relevant biomechanical data. Internal fixation of a single column might not provide adequate stability for transverse fractures, while strength of single plate plus column screw fixation and double plate fixation was comparable.

Fixation of Transverse Acetabular Fractures With Precontoured Plates Alone Causes Fracture Malreduction: A Biomechanical Assessment.

Precontoured quadrilateral surface buttress (PQSB) plates have grown in popularity for acetabular fracture fixation. However, our experience has pushed us to hypothesize that their use as sole means of fixation may cause fracture malreduction. A biomechanical model was created to investigate this theory. A transverse acetabular fracture was created and reduced anatomically in 18 synthetic hemipelvises. The reduced hemipelvises were fixated using 3 different techniques. Group A fixation included anterior and posterior column screws plus a suprapectineal pelvic reconstruction plate; group B models were fixed using a PQSB plate only; and group C models were fixed with an anterior column screw and a PQSB plate. Acetabular tracking points were placed before final fixation and used to quantify any postfixation displacement. One-way analysis of variance and Tukey HSD testing were used to determine the significant difference (P < 0.05). Models in group B had significant fracture displacement after final fixation when compared with group A and group C models. The average amount of displacement at the anterior column and within the acetabulum was 1.37 mm (95% CI, 1.08-1.65) in group B constructs compared with 0.32 mm (95% CI, 0.22-0.42) and 0.26 mm (95% CI, 0.15-0.38) in groups A and C constructs, respectively. There were no significant differences in displacement after final fixation between group A and group C models. PQSB plates for acetabular fractures cause malreduction when applied in isolation in this biomechanical model. If a PQSB plate is chosen for fixation, we suggest the use of a columnar lag screw at minimum to hold reduction before plate application.

Posterolateral clamp placement on the pelvic brim provides optimal reduction of transtectal acetabular fractures fixed through the anterior intrapelvic approach.

To determine the optimal position of reduction clamps applied to reduce transtectal transverse acetabular fractures approached through the anterior intrapelvic route. Transtectal transverse fractures were created in sawbone hemipelvis models. Fractures were reduced and held with a large pointed reduction clamp with one tine centered on the quadrilateral plate and the other placed in one of nine various positions on the pelvic brim accessible from the anterior intrapelvic (AIP) approach. Reduction was assessed by measuring maximum gapping and step-off at the joint surface. The posterolateral pelvic brim clamp position provided the most accurate reduction with the smallest articular fracture gap (mean 1.09 ± 1.05 mm) and step-off (mean 0.87 ± 1.35 mm). This clamp position, compared with the other positions as a whole, also yielded the highest proportion of perfect reductions (0 mm maximum displacement) for both step-off (83% vs 34%; RR 2.4, 95% CI 1.7-3.2) and gap (88% vs 49%; RR 1.8, 95% CI 1.4 to 2.2). When clamping transtectal fractures through the AIP approach, positioning the clamp posterolaterally on the pelvic brim appears to provide the best reduction in this fracture model.

Simulation for Reduction of Transverse Acetabular Fractures in Sawbones Models

Simulation for Reduction of Transverse Acetabular Fractures in Sawbones Models

Single versus double column fixation in transverse fractures of the acetabulum: A randomised controlled trial

IntroductionBiomechanical studies have compared fixation methods in transverse acetabular fractures, yet there is not enough clinical data to suggest an optimal fixation method. The aim of this randomized controlled trail was to compare fracture stability in posterior plating alone versus posterior plating and anterior column lag-screw fixation in treatment of transverse and transverse with posterior wall acetabular fractures. MethodsThirty patients were randomized to one of two groups, either posterior fixation alone (single column group), or posterior plating and anterior fixation with percutaneous anterior column screw (double column group). Patients were followed up with serial radiographic assessments documenting any loss of reduction, utilizing Matta’s radiological criteria, measuring the roof arc angles and by measuring any change in the femoral head offset. ResultsFifteen patients were randomized to each group. Mean patient age was 31 years, mean follow up period was 19 months (range 12–24). There was no significant differences between the two groups with regards the quality of post-operative reduction, blood loss, hospital stay and functional score using the modified Merle D'Aubinge and Postel score. The operative time was significantly longer in the double column fixation group (130 min versus 104 min). There was no loss of reduction observed in either of the two groups. ConclusionSingle poster column fixation in transverse and transverse posterior wall fractures showed similar result to double column fixation, in terms of fractures stability in the follow up period, quality of reduction and early functional outcome.

Le fratture trasverse di acetabolo e il loro trattamento

Transverse acetabular fractures are demanding and challenging for orthopaedic surgeons and they represent up to 22% of all acetabular fractures. They involve either the anterior or the posterior column; reduction of both columns may not be easy using a single approach. Usually the iliofemoral or the Langenbeck approaches are used to reduce and fix those fractures but their limit is poor control in the reduction of the opposite column. A safe hip dislocation technique has been proposed to avoid this limit and in the literature good results are reported. Anatomic reduction and stable fixation are essential to achieve good results and to procrastinate arthritis in young patients. In the elderly, transverse fractures may be treated with direct total hip arthroplasty associated with posterior column fixation although these treatments involve high complications rates.

The Central Dislocation of Femoral Head in the Transverse and Both Column Acetabular Fractures: Is It Really Medialized?

PurposeWe hypothesized that the central dislocation of the femoral head does generally not occur in transverse acetabular fractures, although it does usually occur in both column fractures.Materials and MethodsFifty-two transverse and both column acetabular fracture cases were evaluated retrospectively. The distances between (a) the sciatic notch on the fracture side and the vertical axis of the pelvis (VA line) and (b) the contralateral intact sciatic notch and the VA line were measured. The a/b ratio corresponded to the superior iliac segment displacement or rotation. The ratio of the distance between the fracture side femoral head and the VA line (c) and the distance between the contralateral intact femoral head and the VA line (d) corresponded to the femoral head displacement. The width of ischium (e) on fractured side and (f) contralateral side were measured. The e/f ratio increment reflected ischiadic fragment mobility.ResultsThe median value of femoral head displacement (c/d) of the transverse fracture group (n=25) was 1.02 (1.000-1.07). Ischiadic fragment rotation (e/f ratio) of the transverse fracture group was 1.000. The median value of femoral head displacement (c/d) of the both column fractures (n=27) was 0.78 (0.64-0.85). Ischiadic fragment rotation (e/f ratio) of the both-column group was 1.15 (1.06-1.23). The differences between groups according to measurements were statistically significant.ConclusionIn contrary to Letournel description, our findings showed no medialization of femoral head in transverse acetabular fractures in general. This might be an illusion resulting from external rotation of the superior iliac segment.

Rapidly Progressive Osteolysis of the Femoral Head Following An Acetabular Fracture - Case Report

Posttraumatic osteolysis is a rare complication of fractures. We present a case of massive, rapidly progressive osteolysis of the femoral head following a fracture of the acetabulum. A 45 years old male patient suffered a transverse acetabular fracture that involved the posterior wall. Through a Kocher-Langenbeck approach we performed open reduction and internal fixation of the fracture with two reconstruction plates. Postoperative radiologic control showed acceptable fracture reduction. At 45 days after surgery, a routine X-ray control was performed and a massive osteolysis involving about 50% of the femoral head was noticed. Three months after the surgery, quasi-total disappearance of the femoral head with superior dislocation of the remaining blunt was observed. Massive osteolysis of the femoral head is a new entity of post-traumatic osteoarthritis described in a small number of patients which should not be confused with aseptic necrosis or rapidly progressive osteoarthritis.

The added value of intraoperative CT scanner and screw navigation in displaced posterior wall acetabular fracture with articular impaction

Posterior wall with transverse acetabular fractures represents the most common type of acetabular fractures and is generally associated with poorer outcomes. This is caused by improper visualization of the fragments leading to imperfect reductions. Navigation in pelvic and acetabular trauma is reserved nowadays to non-displaced or mildly displaced fractures. To add to that, perioperative control of reduction is difficult using the conventional X-ray. The described 3D imaging method allowed proper reduction control. On the other hand, screw navigation of acetabular screws enabled better control of screw position as well as screw placement in otherwise inaccessible zones. In conclusion, peroperative 3D imaging and screw navigation optimize fracture reduction promoting better radiological and functional results.

Finite element analysis of the stability of transverse acetabular fractures in standing and sitting positions by different fixation options

BackgroundTreatment of a transverse acetabular fracture type is possible from an anterior approach, a posterior approach or both. Different fixation methods have been described but whether one is superior to the other is still under debate. The aim of the current study was to test the different fixation alternatives of stabilization of transverse acetabular fractures under two basic physiological loading conditions: standing and sitting utilizing a finite element model. Material and methodsA transtectal transverse fracture model was fixed in five different alternatives: an anterior column plate; a posterior column plate; an anterior column plate combined with a posterior column screw; a posterior column plate combined with an anterior column screw; and a posterior column plate and an anterior column plate. In these models, a load of 400N was applied at standing and sitting positions and the displacements were analyzed by using three-dimensional finite element stress analysis method. ResultsIn the model simulating standing human position, overall motion at the posterior column was minimum when two columns were plated (0.071mm). The second best fixation was posterior column plate with an anterior column screw (0.077mm). Overall motion at the anterior column was minimum by posterior column plate with an anterior column screw (0.0326mm). The plating of two columns was associated with motion of (0.0333mm).In the model that simulates sitting position, the motion at the posterior column was minimum when two columns were plated (0.0478mm), and (0.0517mm) when a posterior column plate with an anterior column screw was used. Overall motion in the anterior column was minimum when posterior column plate with an anterior column screw (0.0198mm) was used, whereas the motion was (0.0203mm) when plating of both columns was examined. ConclusionPosterior column plating combined with an anterior column screw has quite comparable results to a both column plating in transverse fractures, suggesting that two column fixations might be unnecessary. This method is also very superior to anterior column plating combined with a posterior column screw in that type of fractures.