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Posterior wall fractures of the acetabulum: treatment using an anatomical plate through direct posterior approach

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objectives

This study was aimed to measure the application of W-shaped acetabular angular plate (WAAP) through direct posterior approach (DPA) on the reconstruction of acetabular posterior wall fractures when compared with reconstruction plates.

Patients and Methods

A retrospective study was performed on patients treated with the WAAP or reconstruction plates via the DPA. The intraoperative data of operative time, blood loss and radiation exposure times were recorded. Radiographs of the pelvis and CT scan were obtained within one week post-operation to assess the reduction quality. The clinical outcome was evaluated by the modified Merle d’Aubigne and Postel score.

Results

From May 2016 to October 2019, a total of 41 patients with simple acetabular posterior wall fractures were included in this study, 22 from the WAAP group and 19 from the reconstruction plates group. There were no significant differences between the two group in age, gender, time from injury to operation, cause of injuries, length of incision and follow-up time (P > 0.05). In comparison with the reconstruction plates group, the average operation time of the WAAP group was significantly shorter (46.1 ± 12.7 min vs 59.2 ± 17.4 min, P < 0.05), the average radiation exposure times were significantly less (2.3 ± 0.6 vs 3.6 ± 1.0, P < 0.001), the average blood loss was significantly less (240 ± 98.9 ml vs 301.1 ± 66.6 ml, P < 0.05). According to Matta radiology criteria and the modified Merle d’ Aubigne and Postel score, no significant difference was observed between the two group, as for the quality of reduction and function outcomes.

Conclusion

The application of WAAP through DPA showed satisfactory preliminary clinical outcomes, showing promise to be an alternative technique for the treatment of acetabular posterior wall fractures.

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Abbreviations

WAAP:

W-shaped acetabular angular plate

DPA:

Direct posterior approach

References

  1. Baumgaertner MR (1999) Fractures of the posterior wall of the acetabulum. J Am Acad Orthop Surg 7(1):54–65

    Article  CAS  PubMed  Google Scholar 

  2. Ebraheim NA et al (2007) Reconstruction of comminuted posterior wall fractures using the buttress technique: a review of 32 fractures. Int Orthop 31(5):671–675

    Article  PubMed  Google Scholar 

  3. Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78(11):1632–1645

    Article  CAS  PubMed  Google Scholar 

  4. Mears DC, Velyvis JH, Chang C (2003) Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res 407(407):173–186

    Article  Google Scholar 

  5. Moed BR, McMichael JC (2008) Outcomes of posterior wall fractures of the acetabulum. J Bone Joint Surg Am 90(Suppl 2):87–107

    Article  PubMed  Google Scholar 

  6. Freitas A et al (2012) Anatomical description of the proximal third of the medial femoral circumflex artery. A cadaveric study. Acta Ortop Bras 20(1):21–24

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chen W et al (2014) Fluoroscopic views for safe insertion of lag screws into the posterior column of the acetabulum. BMC Musculoskelet Disord 15:303

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gänsslen A et al (2016) Standard approaches to the acetabulum part 1: Kocher–Langenbeck approach. Acta Chir Orthop Traumatol Čech 83(3):141

    Article  PubMed  Google Scholar 

  9. Magu NK et al (2011) Modified Kocher–Langenbeck approach for the stabilization of posterior wall fractures of the acetabulum. J Orthop Trauma 25(4):243–249

    Article  PubMed  Google Scholar 

  10. Cutrera NJ, Pinkas D, Toro JB (2015) Surgical approaches to the acetabulum and modifications in technique. J Am Acad Orthop Surg 23(10):592–603

    Article  PubMed  Google Scholar 

  11. Huang FM et al (2019) A novel approach for posterior acetabular fractures: surgical technique. Math Biosci Eng 16(6):7950–7962

    Article  PubMed  Google Scholar 

  12. Zhang Q et al (2014) Comparative study of W-shaped angular plate and reconstruction plate in treating posterior wall fractures of the acetabulum. PLoS ONE 9(3):e92210

    Article  PubMed  PubMed Central  Google Scholar 

  13. Su K et al (2017) Posterior column acetabular fracture fixation using a W-shaped angular plate: a biomechanical analysis. PLoS ONE 12(11):e0187886

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li H et al (2014) Fractures of the posterior wall of the acetabulum: treatment using internal fixation of two parallel reconstruction plates. Injury 45(4):709–714

    Article  PubMed  Google Scholar 

  15. Matta JM (2006) Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. J Orthop Trauma 20(1 Suppl):S20–S29

    Article  PubMed  Google Scholar 

  16. Matta JM, Mehne DK, Roffi R (1986) Fractures of the acetabulum. Early results of a prospective study. Clin Orthop Relat Res 205:241–50

    Article  Google Scholar 

  17. D’AUBIGNE RM, POSTEL M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 36(A 3):451–75

    Article  PubMed  Google Scholar 

  18. Brooker AF et al (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–32

    Article  CAS  PubMed  Google Scholar 

  19. Moed BR, Smith ST (1996) Three-view radiographic assessment of heterotopic ossification after acetabular fracture surgery. J Orthop Trauma 10(2):93–98

    Article  CAS  PubMed  Google Scholar 

  20. Im G, Shin Y, Song Y (2005) Fractures to the posterior wall of the acetabulum managed with screws alone. J Trauma 58(2):300–303

    Article  PubMed  Google Scholar 

  21. Giannoudis PV, Tzioupis C, Moed BR (2007) Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. J Bone Joint Surg Br 89(4):503–509

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was supported by the National Natural Science Foundation of China (No. 81772428 and No. 82072411) and Innovation fund cultivation project of National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation (2021-NCRC-CXJJ-PY-06).

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Author notes

  1. Wenquan Xu and Zhenhua Zhu contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Traumatic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Tianhe District, No.183, Zhongshan Dadao West Street, Guangzhou, 510630, China

    Wenquan Xu, Zhenhua Zhu, Qiguang Mai & Shicai Fan

  2. Affiliated Maoming Hospital of Southern Medical University, Maoming, 525000, China

    Fuming Huang

  3. Department of Traumatic Surgery, Center for Orthopaedic Surgery, Guangzhou, 510630, Guangdong, China

    Shicai Fan

Authors
  1. Wenquan Xu
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  2. Zhenhua Zhu
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  3. Fuming Huang
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  4. Qiguang Mai
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  5. Shicai Fan
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Corresponding author

Correspondence to Shicai Fan.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The present study was proved by the Ethics Committee of the Third Affiliated Hospital of Southern Medical University, Guangzhou, China (approval number: IEC‑AF/17–1.0).

Informed consent

All patients gave their written informed consent. All procedures involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Xu, W., Zhu, Z., Huang, F. et al. Posterior wall fractures of the acetabulum: treatment using an anatomical plate through direct posterior approach. Arch Orthop Trauma Surg 143, 3669–3675 (2023). https://doi.org/10.1007/s00402-022-04546-7

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  • DOI: https://doi.org/10.1007/s00402-022-04546-7

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