Application of customized variable-angle locking acetabular wing plates in treatment of acetabular fractures in the elderly via the lateral-rectus approach / 中华骨科杂志

ABSTRACT

Objective To evaluate clinical efficacy and surgical techniques of customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly through the lateral-rectus approach.Methods Data of 11 elder patients of complex acetabular fractures (mean age 75 y,range60-93 y;8 males,3 females) admitted to our department from March 2016 to March 2017 were retrospectively analyzed.According to Judet-Letournel classification of acetabular fractures,there were 2 cases of anterior column and posterior hemitransverse fractures,9 cases of both-column fractures.The customized variable-angle locking acetabular wing plates were designed by mimics software and then produced before surgery.During the operation,the customized variable-angle locking acetabular wing plate was applied to reduction and fixation via the anterior lataralrectus approach.The effect of fracture reduction was assessed by Matta's criteria.The clinical effect was assessed by Harris Hip score and the modified Merle d' Aubigné-Postal score at the 6th month of postoperative follow-up.Results The average time of designing and producing customized variable-angle locking acetabular wing plates was 4 d (3-5 d),the average operation time was 95 min (45-150 min),and the average intraoperative bleeding was 600 ml (250-1 400 ml).All patients were followed up,with an average follow-up of 18 m (6-24 m).All fractures were healed,with an average healing time of 8 weeks (6-12 weeks).Reduction qualityexcellent in 8 cases,good in 2 cases,poor in 1 case,with an overall excellent and good rate of 90.9％.The result of Harris Hip scoringexcellent in 7 cases,good in 3 cases,and acceptable in 1 case,with a total excellent and good rate of 90.9％;Modified Mere d' Aubigné-Postal soringexcellent in 6 cases,good in 3 cases,and acceptable in 2 cases,with an overall excellent and good rate of 81.8％.There were 2 cases of obturator nerve injury,1 case of fat liquefaction of incision,3 cases of traumatic hip arthritis.During the follow-up,no complications such as ectopic ossification,plate fracture and screw loosening were found.Conclusion The customized variable-angle locking acetabular wing plates in treatment of complex acetabular fractures in the elderly via the lateral-rectus approach can achieve satisfactory reduction and firm fixtation.