Comparative study of anatomical locking plate and reconstruction plate in treating acetabular fractures

Abstract

Purpose

This study aims to compare the effectiveness of anatomic locking plate and reconstruction plate used in treating acetabular fractures.

Methods

From January 2009 to January 2016, patients with acetabular fractures were included in this retrospective study. We grouped the patients into two groups based on the internal fixation: reconstruction plate group (RPG) and anatomic locking plate group (ALPG). The operation time, blood loss, intra-operative screw penetration, and plate breakage were compared between the two groups. The intra-operative fluoroscopic images were used to evaluate the fixation location. The quality of reduction and radiological grading were assessed according to the criteria developed by Matta. The clinical assessment was based on the Merle d’Aubigne-Postel score.

Results

Eighty-three patients were included in this study and were followed up for an average of 35 months (range, 25 to 42 months). Thirty-five patients were treated with the anatomical locking plate, and 48 patients were treated with the reconstruction plate. The mean surgical time was significantly shorter (P < 0.0001) in ALPG patients than in RPG patients, and the intra-operative blood loss was significantly lower (P = 0.008). The rates of intra-operative screw penetration or plate breakage in the ALPG (0/35) are significantly lower than that in the RPG (7/48) (P = 0.018). Post-operative Matta score (P = 0.905), Merle d’Aubigne-Postel score (P = 0.957), and overall complication rates (P = 0.391) were not significantly different among the groups.

Conclusion

Patients treated by anatomical locking plate had shorter operation time, less bleeding, and lower rate screw perforation compared to patients treated by reconstruction plate. Anatomical locking plate is a better choice for acetabulum fractures, especially complicated fractures.

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Availability of data and materials

Data and materials relating to the study were accessed from the case systems at our department.

References

  1. 1.

    Guerado E, Cano JR, Cruz E (2012) Fractures of the acetabulum in elderly patients: an update. Injury 43(Suppl 2):S33–S41. https://doi.org/10.1016/s0020-1383(13)70177-3

    Article  PubMed  Google Scholar 

  2. 2.

    Baschera D, Rad H, Collopy D, Zellweger R (2015) Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: retrospective cohort and case control study. J Orthop Surg Res 10:60. https://doi.org/10.1186/s13018-015-0202-z

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H (2005) Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg (Br) 87(1):2–9

    CAS  Article  Google Scholar 

  4. 4.

    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

    CAS  Article  Google Scholar 

  5. 5.

    Zhang Q, Chen W, Wu X, Yanling S, Hou Z, Zhang Y (2014) Comparative study of W-shaped angular plate and reconstruction plate in treating posterior wall fractures of the acetabulum. PLoS One 9(3):e92210. https://doi.org/10.1371/journal.pone.0092210

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Anizar-Faizi A, Hisam A, Sudhagar KP, Moganadass M, Suresh C (2014) Outcome of Surgical Treatment for Displaced Acetabular Fractures. Malays Orthop J 8(3):1–6. https://doi.org/10.5704/moj.1411.001

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Ebraheim NA, Savolaine ER, Hoeflinger MJ, Jackson WT (1989) Radiological diagnosis of screw penetration of the hip joint in acetabular reconstruction.J. Orthop Traumatol 3(3):196–201. https://doi.org/10.1097/00005131-198909000-00003

    CAS  Article  Google Scholar 

  8. 8.

    Anglen JO, DiPasquale T (1994) The reliability of detecting screw penetration of the acetabulum by intraoperative auscultation (1994). J Orthop Trauma 8(5):404–408. https://doi.org/10.1097/00005131-199410000-00006

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Carmack DB, Moed BR, McCarroll K (2001) Accuracy of detecting screw penetration of the acetabulum with intraoperative fluoroscopy and computed tomography. J Bone Joint Surg Am 83 A(9):1370–1375. https://doi.org/10.2106/00004623-200109000-00012

    Article  Google Scholar 

  10. 10.

    Xu M, Zhang L-H, Zhang Y-Z, He C-Q, Zhang L-C, Wang Y, Tang P-F (2013) Development of Site-specific locking Plates for Acetabular Fractures. Orthopaedics 36(5):593–600. https://doi.org/10.3928/01477447-20130426-21

    Article  Google Scholar 

  11. 11.

    Xu M, Zhang L-H, Zhang Y-Z, Zhang L-C, He C-Q, Wang Y, Tang P-F (2014) Custom-made Locked Plating for Acetabular Fracture: A Pilot Study in 24 Consecutive Cases. Orthopaedics 37(7):660–669. https://doi.org/10.3928/01477447-20140626-59

    Article  Google Scholar 

  12. 12.

    Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res (151):81–106

  13. 13.

    Norris BL, Hahn DH, Bosse MJ, Kellam JF, Sims SH (1999) Intraoperative fluoroscopy to evaluate fracture reduction and hardware placement during acetabular surgery. J Orthop Trauma 13(6):414–417. https://doi.org/10.1097/00005131-199908000-00004

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Ochs BG, Marintschev I, Hoyer H, Rolauffs B, Culemann U, Pohlemann T, Stuby FM (2010) Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU). Injury 41(8):839–851. https://doi.org/10.1016/j.injury.2010.04.010

    Article  PubMed  Google Scholar 

  15. 15.

    Murphy D, Kaliszer M, Rice J, McElwain JP (2003) Outcome after acetabular fracture: prognostic factors and their inter-relationships. Injury 34(7):512–517. https://doi.org/10.1016/s0020-1383(02)00349-2

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Shazar N, Eshed I, Ackshota N, Hershkovich O, Khazanov A, Herman A (2014) Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified Rives–Stoppa) surgical approaches. J Orthop Trauma 28(6):313–319. https://doi.org/10.1097/01.bot.0000435627.56658.53

    Article  PubMed  Google Scholar 

  17. 17.

    Liu X, Xu S, Zhang C, Jiacan S, Yu B (2010) Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China. Int Orthop 34(7):1033–1040. https://doi.org/10.1007/s00264-009-0867-1

    Article  PubMed  Google Scholar 

  18. 18.

    Ferguson TA, Patel R, Bhandari M, Matta JM (2010) Fractures of the acetabu1um in patients aged 60 years and older:an epidemiological and radiological study. J Bone Joint Surg (Br) 92(2):250–257. https://doi.org/10.1302/0301-620x.92b2.22488

    CAS  Article  Google Scholar 

  19. 19.

    Cornell CN (2004) Hip fractures in the elderly: on the acetabular side. Orthopedics 27(9):931–932

    Article  Google Scholar 

  20. 20.

    Pagenkopf E, Grose A, Partal G, Helfet DL (2006) Acetabular fractures in the elderly: treatment recommendations. HSS J 2(2):161–71. https://doi.org/10.1007/s11420-006-9010-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Abdulla J, Awaiz A, Rees WM (2019) Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study. Int Orthop 43(7):1695–1699. https://doi.org/10.1007/s00264-018-4104-7

    Article  Google Scholar 

  22. 22.

    Laird A, Keating JF (2005) Acetabular fractures:a 16-year prospective epidemiological study. J Bone Joint Surg (Br) 87(7):969–973. https://doi.org/10.1302/0301-620x.87b7.16017

    CAS  Article  Google Scholar 

  23. 23.

    Ruipeng Z, Yingchao Y, Ao L, Wang Z, Zhiyong H, Yan Z, Shicai F, Wu Z, Chengla Y, Gang L, Ma X, Yingze Z (2019) Three-Column Classification for Acetabular Fractures: Introduction and Reproducibility Assessment. J Bone Joint Surg Am 101(22):2015–2025. https://doi.org/10.2106/JBJS.19.00284

    Article  Google Scholar 

  24. 24.

    Amer S, Guillaume R, Mourad Z, Peter U, Véronique M, Pomme J (2018) Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop 42(8):1957–1965. https://doi.org/10.1007/s00264-018-3810-5

    Article  Google Scholar 

  25. 25.

    Fornaro J, Keel M, Harders M, Marincek B, Székely G, Frauenfelder T (2010) An interactive surgical planning tool for acetabular fractures: initial results. J Orthop Surg Res 5:50. https://doi.org/10.1186/1749-799X-5-50

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Antell NB, Switzer JA, Schmidt AH (2017) Management of Acetabular Fractures in the Elderly. J Am Acad Orthop Surg 25(8):577–585. https://doi.org/10.5435/jaaos-d-15-00510

    Article  PubMed  Google Scholar 

  27. 27.

    Kendoff D, Gardner MJ, Citak M, Kfuri M Jr, Thumes B, Krettek C, Hüfner T (2008) Value of 3D fluoroscopic imaging of acetabular fractures comparison to 2D fluoroscopy and CT imaging. Arch Orthop Trauma Surg 128(6):599–605. https://doi.org/10.1007/s00402-007-0411-y

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Stockle U, Schaser K, Konig B (2007) Image guidance in pelvic and acetabular surgery—expectations, success and limitations. Injury 38(4):450–462. https://doi.org/10.1016/j.injury.2007.01.024

    Article  PubMed  Google Scholar 

  29. 29.

    Chang JK, Gill SS, Zura RD, Krause WR, Wang GJ (2001) Comparative strength of three methods of fixation of transverse acetabular fractures. Clin Orthop Relat Res 392:433–441. https://doi.org/10.1097/00003086-200111000-00057

    Article  Google Scholar 

  30. 30.

    Mehin R, Jones B, Zhu Q, Broekhuyse H (2009) A biomechanical study of conventional acetabular internal fracture fixation versus locking plate fixation. Can J Surg 52(3):221–228

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ (2004) Biomechanics of locked plates and screws. J Orthop Trauma 18(8):488–493. https://doi.org/10.1097/00005131-200409000-00003

    Article  PubMed  Google Scholar 

  32. 32.

    Siyu T, Yajie C, Yingchao Y, Ruipeng Z, Zhiyong H, Yingze Z (2019) Morphological Characteristics of Posterior Wall Fragments Associated with Acetabular Both-column Fracture. Sci Rep 9(1):20164. https://doi.org/10.1038/s41598-019-56838-5

    CAS  Article  Google Scholar 

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Authors

Contributions

Peifu Tang and Licheng Zhang: contribution to the research design, data acquisition, and revising it critically; Zhijiang Li and Jiantao Li: data acquisition, drafting the paper, and approval of the submitted and final version; Zhirui Li, Shaobo Nie, and Hao Zhang: data acquisition, statistical analysis, and approval of the submitted and final version; Ming Li, Jianheng Liu, Zhongyang Liu, and Gaoxiang Xu: data acquisition and approval of the submitted and final version.

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Correspondence to Licheng Zhang or Peifu Tang.

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The study has been approved by the Ethics Committee of Chinese PLA General Hospital under Grant No. S2020-115-01 and written informed consent was obtained from the patients for the publication of individual clinical details and accompanying images. This research has been conducted according to the ethical principles expressed in the Declaration of Helsinki.

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Written informed consent was obtained from the patients for the publication of individual clinical details and accompanying images.

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Cite this article

Li, Z., Li, J., Li, Z. et al. Comparative study of anatomical locking plate and reconstruction plate in treating acetabular fractures. International Orthopaedics (SICOT) (2021). https://doi.org/10.1007/s00264-021-04970-1

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Keywords

  • Anatomical locking plate,
  • Reconstruction plate,
  • Acetabular fractures