A novel technique for posterior internal fixation of acetabular fractures.

PURPOSE

To evaluate the surgical technique and clinical outcomes of the Universal Self-locking Anatomic Plate for Acetabulum (USAPA).

METHODS

A retrospective analysis of 155 patients with complete follow-up data from December 2014 to December 2020 was conducted. The study included 119 males and 36 females, aged 18–82 (mean: 40.31 ± 6.96) years. Among the cases, 65 were on the left side and 90 on the right side. The time from injury to surgery ranged from 3.5 to 51 (mean: 5.43 ± 2.84) days. The Letournel–Judet classification included posterior wall fractures in 67 cases, transverse with posterior wall in 51 cases, anterior column with posterior wall in 15 cases, transverse in 10 cases, double-column in 10 cases, anterior column with posterior hemitransverse in 2 cases, T type in 2 cases, posterior column with posterior wall in 1 case, and Pipkin’s type IV in 1 case. The Kocher–Langenbeck approach was applied. Matta’s imaging and modified Merle Aubigne’s criteria were used to assess the outcome. The clinical outcomes and surgery-related complications were compared with the literature.

RESULTS

The mean implant placement time was 17.0 ± 2.5 min, the mean operation time was 114.25 ± 21.5 min, the mean intraoperative C-arm fluoroscopy was 2.5 ± 0.5 times, the mean intraoperative blood loss was 368.0 ± 12.3 mL, and the mean follow-up duration was 49.5 ± 1.2 months. The mean clinical healing time was 108.7 ± 9.2 days. The rate of excellent and good postoperative imaging assessment was 99.4%, while the rate of functional rates at the last follow-up was 95.5%. Postoperative complications occurred in 3.9% of cases, with no instances of mortality, incisional infection, or sciatic nerve injury. There were no cases of screw penetration into the joint, loss of reduction, implant failure, or nonunion. One case of heterotopic ossification was observed, along with two cases of post-traumatic arthritis. Additionally, one patient with a Pipkin type IV fracture developed femoral head necrosis, ultimately requiring total hip arthroplasty, and two cases exhibited delayed wound healing with incisional fat liquefaction. Overall, intraoperative efficiency, postoperative imaging results, and clinical outcomes were superior compared to those reported in the literature.

CONCLUSION

The USAPA aligns with the acetabulum’s anatomy and biomechanics, providing effective fixation of the weight-bearing dome and posterior wall fragments with safe, efficient screw placement. Compared to similar internal fixation techniques, it offers superior outcomes and fewer complications.

LEVEL OF EVIDENCE

Therapeutic study level IV.