Kordes Felix, Yilmaz Emre, Königshausen Matthias, Schildhauer Thomas A, Hoffmann Martin F
Maria-Josef-Hospital Greven, Greven, Germany.
BG University Hospital Bergmannsheil Bochum, Bochum, Germany.
Eur J Orthop Surg Traumatol. 2025 Mar 17;35(1):118. doi: 10.1007/s00590-025-04251-2.
Acetabular fractures often require stabilization. Fractures involving the quadrilateral plate (QP) remain challenging due to complex anatomy and minimal bone stock. Treatment options include orthogonal double plate fixation or anatomically preformed suprapectineal quadrilateral surface (QLS) plates. The purpose of this study was to evaluate a series of buttress plating of acetabular fractures (OTA/AO 62) comparing orthogonal double plate and QLS plate osteosynthesis regarding surgical procedure, complications, and outcome.
At one level I trauma center, 109 patients underwent internal fixation either by orthogonal double plate osteosynthesis or by preshaped QLS plate. Surgical approach was performed via the first and third windows of the ilioinguinal approach. Reduction quality and osteosynthesis material were checked using CT. Groups were retrospectively evaluated regarding demographic factors, classification, and trauma mechanism. Clinical outcome was assessed utilizing the modified Harris Hip Score (mHHS). Follow-up was 25 months.
Fractures were stabilized using orthogonal double plate osteosynthesis (56%) and QLS plates (44%). Following OTA/AO classification, 16 type A (14.7%), 69 type B (63.3%), and 24 type C (22.0%) fractures underwent treatment. Groups did not differ regarding fracture types, age, or BMI. The majority was male (75%). High-energy trauma accounted for 39.4%. Surgery averaged 187.43 min for orthogonal double plates and 163.13 min for the QLS plate (p = 0.012). No differences were found regarding hospital stay or complications. Neither postoperative osteoarthritis nor mHHS was related to plate type. Patients with high-energy trauma had better mHHS outcomes. Preexisting osteoarthritis resulted in reduced outcome.
Acetabular fracture stabilization is challenging due to extensive approaches, minimal bone stock of the QP, and difficult plate placement. Our analysis confirms that orthogonal double plate fixation and QLS plates provide secure stabilization for acetabular fractures. According to our findings, utilization of the QLS plate may result in reduced OR time due to its anatomically tailored shape.
髋臼骨折通常需要进行固定。由于解剖结构复杂且骨量有限，累及四边形板（QP）的骨折治疗仍具有挑战性。治疗选择包括正交双钢板固定或解剖预成型的耻骨上四边形表面（QLS）钢板。本研究旨在评估一系列髋臼骨折（OTA/AO 62）的支撑钢板固定术，并比较正交双钢板和QLS钢板在手术过程、并发症及疗效方面的差异。
在一家一级创伤中心，109例患者接受了正交双钢板内固定或预成型QLS钢板内固定。手术入路通过髂腹股沟入路的第一和第三窗口进行。使用CT检查复位质量和内固定材料。对两组患者的人口统计学因素、骨折分类和创伤机制进行回顾性评估。采用改良Harris髋关节评分（mHHS）评估临床疗效。随访时间为25个月。
采用正交双钢板内固定（56%）和QLS钢板内固定（44%）对骨折进行固定。根据OTA/AO分类，16例A型（14.7%）、69例B型（63.3%）和24例C型（22.0%）骨折接受了治疗。两组在骨折类型、年龄或体重指数方面无差异。大多数患者为男性（75%）。高能创伤占39.4%。正交双钢板手术平均用时187.43分钟，QLS钢板手术平均用时163.13分钟（p = 0.012）。在住院时间或并发症方面未发现差异。术后骨关节炎和mHHS均与钢板类型无关。高能创伤患者mHHS结局更好。术前存在骨关节炎导致结局较差。
由于手术入路广泛、QP骨量有限以及钢板放置困难等原因，髋臼骨折固定具有挑战性。我们的分析证实正交双钢板固定和QLS钢板可为髋臼骨折提供可靠的固定。根据我们的研究结果，由于QLS钢板具有解剖学定制形状，可以缩短手术时间。
