Surgical treatment of acetabular fractures: a comparative cohort study comparing orthogonal double plating to suprapectineal quadrilateral surface (QLS) plate osteosynthesis.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Discussion: 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.