The efficacy of posterior plating and anterior column screw fixation in the management of T-shaped acetabular fractures - CART analysis of prospective cohort study.

T-shaped acetabular fractures are challenging injuries. The goal of surgical treatment is to achieve a stable and a concentric reduction of the femoral head under the anatomically reduced weight-bearing dome. There is an ongoing debate about the ideal approach and fixation method for T-shaped fractures. In this study, a group of 34 patients with T-shaped acetabular fractures were treated by posterior plating and anterior column screw. All patients, were followed for at least two years or until hip replacement. The aim of this prospective cohort study was to report the rate of postoperative radiological results together with the early clinical outcome. Anatomical reduction was achieved in 62%, satisfactory reduction of the anterior column with restoration of hip congruency in 82% with excellent to good clinical outcome in 75% of cases. We used classification regression trees (CART) to select the important predictors and generate hypotheses on interaction among them. Residual anterior column displacement >3.5mm was associated with poor clinical results. In cases with residual displacement <3.5mm, the presence of a posterior wall fracture was an independent negative predictor.

Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches.

In acetabular fractures, the correct choice of the surgical approach is mandatory to achieve accurate reduction and to avoid complications. Anterior approaches include the ilio-inguinal, the Stoppa, the ilio-femoral and the para-rectal exposures. The first two are the most commonly used approaches nowadays. The aim of this study was to compare these two approaches. The standard three window ilio-inguinal approach was compared to the intra-pelvic Stoppa approach with an added iliac window. The study enrolled 54 patients. Patients were divided into two groups. The first group consisted of 33 patients presented with acetabular fractures and had ORIF starting with an ilio-inguinal exposure. This group was compared to a second group of 21 patients who were treated with the Stoppa/iliac window approach. All patients were treated by one surgical team. The accuracy of reduction, the early clinical results and the approach related complications were compared.