Anterior fixation with oblique-ilioischial plate for acetabular fractures of lower posterior column / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the effectiveness of anterior fixation with an oblique-ilioischial plate for acetabular fractures of lower posterior column.Methods A consecutive series of 7 patients were retrospectively reviewed who had been treated operatively from August 2016 to July 2017 for acetabular fractures of lower posterior column.They were 4 men and 3 women,aged from 45 to 62 years (average,48.6 years).The injury was caused by a traffic accident in 4 cases and by falling from a height in 3.By the Letournel-Judet classification,there were one case of transverse fracture,3 cases of T-shaped fracture,2 cases of anterior + posterior hemitransverse fracture and one case of associated both column fracture.The intervals from injury to operation ranged from 6 to 19 days (average,7 days).All of them were treated by the modified Stoppa approach (or combined with an iliac fossa approach).The anterior column was stabilized with a reconstruction plate for the iliac wing along the iliopectineal line to the pubis in all cases.The lower posterior column was fixated with a newly developed oblique-ilioischial plate running from the ilium to the ischial ramus.Operative time,intraoperative blood loss,reduction quality and postoperative function of the affected hip were recorded.Results The operative time for this cohort ranged from 1.0 to 3.2 h (average,2.1 h) and the intraoperative blood loss from 200 to 500 mL (average,300 mL).The postoperative reduction was rated by the Matta's criteria as excellent in 5 cases,as good in one and as fair in one.This cohort was followed up for 7 months (from 6 to 9 months).At the final follow-up,the hip function was rated by the modified Merle d'Aubigne-Postel scale as excellent in 5 cases,as good in one and as fair in one.Fracture healing was achieved in all the patients after 3 to 6 months (average,4.5 months).No implant failure,infection,heterotopic ossification or neurovascular injury occurred during the follow-up.Conclusion Anterior fixation with an oblique-ilioischial plate via the modified Stoppa approach or combined with an iliac fossa approach is a good treatment for acetabular fractures involving the lower column,due to its advantages of reliable fixation,limited invasion,little intraoperative bleeding and few complications.