Preliminary Clinical Study On The Treatment Of Acetabular Fractures With A Novelacetabular Quadrilateral Anatomical Locking Plate

Objective:This study aims to investigate the surgical approaches,clinical efficacy,and indications of a novel acetabular quadrilateral anatomical locking plate for acetabular fractures involving quadrilateral plate.Methods:Patients with acetabular fractures treated with the novel acetabular quadrilateral anatomical locking plates in our department from December2017 to June 2020 were collected.According to the fracture types,a 1:1matched-pair analysis was carried out and patients treated with reconstruction plates were selected.These two groups of patients were included into novel plate group and reconstruction plate group respectively,and ultimately each group included 11 patients.The time between injury and definitive surgery,surgical approaches,operation time,intraoperative blood loss volume,intraoperative blood transfusion volume,postoperative blood transfusion volume,fracture union time,reduction loss,and postoperative complications were recorded.The fracture reduction quality and hip function were respectively evaluated by Matta’s grading system and modified Merle D’Aubigne-Postel grading system.Comparison was made to observe whether there were differences in the above clinical parameters between the two groups.Results:As for the novel plate group,the mean operation time was327.82±137.46min(range: 120 ～ 580min;median: 323min),the mean intraoperative blood loss volume was 1745.46±2103.98ml(range: 300 ～7000ml;median: 1000ml),and the mean intraoperative blood transfusion volume was 1526.18±1617.46ml(range: 0～5130ml;median: 900ml),and the mean postoperative blood transfusion volume was 254.55±439.01ml(range:0～1400ml;median:0ml);4 single anterior approaches and 7combined approaches were recorded.During the follow-up period ranging from 9 to 28 months,1 incision lipoliquefaction,1 heterotopic ossification,and 1 traumatic arthritis were recorded;According to Matta’s grading system,4 anatomic reduction,6 imperfect reduction,and 1 poor reduction were recorded,and the rate of satisfactory reduction quality was 90.91%;According to modified Merle D’Aubigne-postel grading system,5excellent,4 good,1 fair,and 1 poor were recorded,and the rate of satisfactory hip function was 81.82%.As for the reconstruction plate group,the mean operation time was 273.18±99.15min(range: 120 ～ 450min;median: 270min),the mean intraoperative blood loss volume was1122.73±469.77ml(range: 300～1500ml;median: 1500ml),and the mean intraoperative blood transfusion volume was 608.55±363.71ml(range: 0～1086ml;median: 758ml),the mean postoperative blood transfusion volume was 281.82±430.86ml(range:0～1000ml;median:0ml);4 single anterior approaches,6 combined approaches,and 1 Kocher-Langenbeck approach combined with closed reduction of anterior column fracture were recorded.During the follow-up period ranging from 9 to 42 months,2 traumatic arthritis and 1 femoral head necrosis were recorded;According to Matta’s grading system,2 anatomic reduction,6 imperfect reduction,and 3 poor reduction were recorded,and the rate of satisfactory reduction quality was72.73%;According to modified Merle D’Aubigne-postel grading system,1excellent,7 good,0 fair,and 3 poor were recorded,and the rate of satisfactory hip function was 72.73%.All the patients obtained fracture union,and no reduction loss was recorded.According to statistical analysis,there were no significant differences between the two groups in the time between the injury and definitive surgery,surgical approaches,intraoperative blood loss volume,intraoperative blood transfusion volume,postoperative blood transfusion volume,rate of satisfactory reduction quality,hip function score,and rate of satisfactory hip function.Conclusions:The novel acetabular quadrilateral anatomical locking plate is an integrated plate and consists of one central plate,one extended part,and two lateral wings,of which the shape matches with the acetabular anterior wall,anterior column,and quadrilateral plate.We can integrally fix the fractures of acetabular anterior wall,anterior column,posterior column,and quadrilateral plate with the novel anatomical locking plate through three kinds of anterior approaches.Surgical treatment of acetabular fractures with the novel anatomical locking plate can obtain satisfactory fracture reduction quality,limit the medial displacement of quadrilateral plate effectively,restore the postoperative hip function well,and obtain the comparable clinical efficacy as the reconstruction plate,which is suitable for the acetabular quadrilateral plate fractures with anterior wall fractures,anterior column fractures,transverse fractures,and double-column fractures.