Suprapectineal Plate for Fixation of Both Columns of Complex Acetabular Fractures in a Single Sitting through Anterior Approach- Pushing the Boundaries with the New "Gold Standard".

Abstract

Introduction: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.