Singh Jujhar, Bajaj Vedant, Jain Karun, Saluja Sharandeep Singh
Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, India.
Department of Orthopaedics, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India.
J Orthop Case Rep. 2025 Sep;15(9):353-360. doi: 10.13107/jocr.2025.v15.i09.6124.
Acetabular fractures have increasingly become a prevalent occurrence in the field of orthopedic trauma, and their surgical management continues to present significant challenges for surgeons. The complexity and variability of these fractures often require careful consideration and expertise, making effective treatment a demanding task. Various Complex Fracture patterns, such as anterior column and posterior hemitransverse affect both the anterior and posterior columns of the acetabulum and have been traditionally treated with a combined approach of column plates and lag screw fixation techniques. The aim of this study is to assess the outcomes following fixation of both columns of complex acetabular fractures with predominant anterior displacement, using a suprapectineal plate through Anterior approach (anterior intrapelvic ± Modified Iliofemoral) in a single sitting.
A hospital-based prospective study was done on 31 patients of acetabular fracture with associated quadrilateral plate component were included in our tertiary care center during 1-year period. Patients were followed up clinically and radiologically at 4 weeks, 3 months, 6 months, and 1 year. Functional assessment was done using the Visual Analog Scale score, Harris Hip Score modified, and Merle d'Aubigné score.
31 patients were included in the study with a mean age of 41.96 ± 13.14. Average follow-up was 39.09 ± 8.11 months. Excellent reduction with a congruent hip was achieved in all of our cases. The average intra-operative blood loss and transfusion were 705.48 ± 85.78 mL and 651.61 ± 171.01 mL, respectively. At 1-year follow-up, all fractures showed a satisfactory union with maintained reduction. Clinical outcomes at 1-year follow-up using Merle D'Aubigne and Postel grading were excellent in 61.3% cases, good in 25.8% cases, and fair in 12.9% cases. Radiologically, 2 patients had loosening of the plate from the anterior side; however, fracture had united and the patients could perform all the activities of daily living satisfactorily.
Complex acetabular fractures requiring both column fixations with this revolutionary anatomical plate can further push the boundaries of anterior approaches and might be a new "gold standard" for managing complex acetabular fractures in the future with further long-term results.
髋臼骨折在骨科创伤领域愈发常见，其手术治疗仍给外科医生带来重大挑战。这些骨折的复杂性和多变性常常需要仔细考量并具备专业知识，使得有效治疗成为一项艰巨任务。各种复杂骨折模式，如前柱和后半横行骨折，会影响髋臼的前后柱，传统上采用柱钢板和拉力螺钉固定技术的联合方法进行治疗。本研究的目的是评估采用经耻骨上钢板通过前路（前路骨盆内±改良髂股入路）一次性固定主要向前移位的复杂髋臼骨折双柱后的疗效。
在一年期间，对我们三级医疗中心收治的31例伴有四边形板成分的髋臼骨折患者进行了一项基于医院的前瞻性研究。在4周、3个月、6个月和1年时对患者进行临床和影像学随访。使用视觉模拟评分、改良的Harris髋关节评分和Merle d'Aubigné评分进行功能评估。
31例患者纳入研究，平均年龄41.96±13.14岁。平均随访时间为39.09±8.11个月。所有病例均实现了髋关节的良好复位。术中平均失血量和输血量分别为705.48±85.78 mL和651.61±171.01 mL。在1年随访时，所有骨折均显示满意愈合且复位得以维持。采用Merle D'Aubigné和Postel分级在1年随访时的临床结果显示，61.3%的病例为优，25.8%的病例为良，12.9%的病例为可。影像学检查发现，2例患者的钢板从前侧松动；然而，骨折已愈合，患者能够满意地进行所有日常生活活动。
使用这种具有创新性解剖钢板进行双柱固定的复杂髋臼骨折，可能会进一步拓展前路手术的边界，并且随着进一步长期结果的出现，未来可能成为治疗复杂髋臼骨折的新“金标准”。
