Anatomic quadrilateral surface plate for the treatment of both?column acetabular fractures through Stoppa combined with iliac fossa approach / 中华骨科杂志

ABSTRACT

Objective To explore the clinical outcome an anatomic quadrilateral surface plate for both?column acetabu?lar fractures through the Stoppa combined with iliac fossa approach. Methods A retrospective study of the patients with both?col?umn acetabular fractures treated with an anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa ap?proach from November 2015 to June 2017 was performed. Nineteen patients including 16 males and 3 females met the inclusion criteria. The mean age of included patients was 49.11 years (range, 25-68 years). There were 8 cases of fall injury, 7 cases of car accident injury and 4 cases of crushing injury. There were 11 cases of C1 type injury, 7 cases of C2 type, and 1 case of C3 type ac?cording to Tile classification. Patients included in this study were both?column acetabular fractures according to Letournel?Judet classification. There were six cases associated with posterior wall detachment. Minimally Stoppa combined with iliac fossa ap?proach was performed to manage the displaced fragments. First, the anteromedially displaced iliopubic fragment was managed with a reconstruction plate through iliac fossa approach. Then, the medially displaced ischiadic fragment could be fixed with an anatom?ic quadrilateral surface plate through the Stoppa approach. The reduction quality was assessed by postoperative radiographs and CT scans according to the criteria proposed by Matta. The function of hip joint was assessed by the Merle d’Aubigné?Posteal score modified by Matta. Results The average operation time and blood loss were 115.26 min (range, 90-160 min) and 534.21 ml (range, 300-1000 ml), respectively. The mean length surgical incision was 18.82 cm(range, 16-20 cm). Average follow?up time was 19.84 months (range, 12-28 months). According to Matta criteria of reduction quality, anatomic reduction was obtained in 14 cases, and satisfactory reduction was gained in 3 cases, while unsatisfactory reduction was found in 2 cases (satisfactory rate= 89.47%). All fractures healed well and mean healing time was 3.32 months (range, 3-5 months). The mean Merle d’Aubigné?Post?eal score modified by Matta was 16.95 (range, 13-18), including 12 cases of excellent, 4 cases of good, and 3 cases of fair (satisfac?tory rate=84.21%). Intraoperative injury of lateral femoral cutaneous nerve developed in a case and obturator nerve damage oc?curred in another patient, respectively. Relevant symptoms were totally disappeared after two months’conservative treatment (in?cluding neurotrophic therapy combined with adduction exercise of the affected thigh). Iliac fossa hematoma occurred in a case and relevant symptom was eliminated after puncture. Conclusion Satisfactory clinical outcome of both?column acetabular fractures could be obtained by the anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa approach.