Application of self-made spring plate for treatment of acetabular posterior wall fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 AN Weijun , SUN Jianbin , LI Zhizhong

Department of Traumatic Orthopedics, the General Hospital of Ningxia Medical University, Yinchuan Ningxia, 750004, P.R.China;

Corresponding author：

AN Weijun, Email: anweijun939@163.com

Keywords：

Acetabular posterior wall fracture; spring plate; reconstruction plate; internal fixation

DOI：

10.7507/1002-1892.201906063

Video：

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Objective To investigate the application and effectiveness of self-made spring plate in surgical treatment of acetabular posterior wall fracturejavascript:void(0)s.Methods Between June 2013 and June 2017, 38 patients with acetabular posterior wall fractures were treated. There were 27 males and 11 females with an average age of 53 years (range, 28-68 years). The injury caused by traffic accident in 18 cases, falling from height in 15 cases, and tumble in 5 cases. There were 4 cases of simple posterior wall fracture, 18 cases of posterior wall fracture with posterior dislocation of hip joint, 10 cases of posterior wall fracture with posterior column fracture, and 6 cases of posterior wall fracture with transverse fracture. The time from injury to admission was 1-4 days (mean, 2.5 days). The time from injury to operation was 4-8 days (mean, 5 days). After fracture reduction via the Kocher-Langenbeck approach (35 cases) or the combined ilioinguinal approach (3 cases), the spring plate was used to press the posterior wall fracture, and then the reconstruction plate was pressed against the spring plate and fixed to the posterior column.Results All the incisions healed by first intention. All patients were followed up 12-36 months (mean, 28 months). Five cases of post-traumatic sciatic nerve injury and 2 cases of sciatic nerve injury caused by traction during operation were fully recovered at 3 months after operation. The imaging examination showed that all the fractures healed. The fracture healing time was 10-16 weeks (mean, 12 weeks). There was no ruptures or failures of internal fixation during the follow-up period. There were 2 cases of femoral head necrosis, 1 case of traumatic arthritis, and 1 case of osteomyositis at last follow-up. The hip joint function was rated as excellent in 27 cases, good in 5 cases, fair in 2 cases, and poor in 4 cases according to the Harris scores at 12 months after operation.Conclusion For the acetabular posterior wall fracture, it has the advantages of easy to use and reliable fixation that the posterior wall fracture is fixed with spring plate firstly, and the spring plate is pressed to fix the posterior column with the reconstruction plate finally.

Citation： AN Weijun, SUN Jianbin, LI Zhizhong. Application of self-made spring plate for treatment of acetabular posterior wall fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 27-31. doi: 10.7507/1002-1892.201906063 Copy

1.	吴浩俊, 何艳霞, 陈航, 等. 髋臼后壁软骨面平行角重建螺钉置入安全性的CT扫描图像分析. 中国临床解剖学杂志, 2018, 36(4): 440-444.
2.	Tosounidis TH, Giannoudis VP, Kanakaris NK, et al. The Kocher-Langenbeck approach: state of the art. J JBJS Essent Surg Tech, 2018, 8(2): e18.
3.	Harnroongroj T, Riansuwan K, Sudjai N, et al. Posterior acetabular arc angle of unstable posterior hip fracture-dislocation. Int Orthop, 2013, 37(12): 2443-2449.
4.	Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res, 1980, (151): 81-106.
5.	Ebraheim NA, Waldrop J, Yeasting RA, et al. Danger zone of the acetabulum. J Orthop Trauma, 1992, 6(2): 146-151.
6.	Varga E, Dudas B, Tile M. Putative proprioceptive function of the pelvic ligaments: biomechanical and histological studies. Injury, 2008, 39(8): 858-864.
7.	Goulet JA, Rouleau JP, Mason DJ, et al. Comminuted fractures of the posterior wall of the acetabulum. A biomechanical evaluation of fixation methods. J Bone Joint Surg (Am), 1994, 76(10): 1457-1463.
8.	Schopfer A, DiAngelo D, Hearn T, et al. Biomechanical comparison of methods of fixation of isolated osteotomies of the posterior acetabular column. J Int Orthop, 1994, 18(2): 96-101.
9.	陈林, 张伟, 时珂, 等. 前后联合入路重建带及重建钢板治疗复杂髋臼骨折的疗效比较. 中国修复重建外科杂志, 2016, 30(6): 680-684.
10.	马爱国, 裴宝瑞, 庞智寅, 等. 锁定重建钢板应用于髋臼横行后壁骨折的生物力学研究. 中国修复重建外科杂志, 2016, 30(11): 1354-1357.
11.	Wang H, Utku K, Zhuang Y, et al. Post wall fixation by lag screw only in associated both column fractures with posterior wall involvement. J Injury, 2017, 48(7): 1510-1517.
12.	Mast J, Jakob R, Ganz R. Planning and reduction technique in fracture surgery. Berlin: Springer-Verlag, 1989: 54-56.
13.	Rollmann MF, Holstein JH, Pohlemann T, et al. Predictors for secondary hip osteoarthritis after acetabular fractures-a pelvic registry study. J Int Orthop, 2019, 43(9): 2167-2173.
14.	Boudissa M, Ruatti S, Kerschbaumer G, et al. Part 2: outcome of acetabular fractures and associated prognostic factors-a ten-year retrospective study of one hundred and fifty six operated cases with open reduction and internal fixation. J Int Orthop, 2016, 40(10): 2151-2156.
15.	Cahueque M, Martínez M, Cobar A, et al. Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?. J Clin Orthop Trauma, 2017, 8(4): 320-326.
16.	Pascarella R, Cerbasi S, Politano R, et al. Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture. J Injury, 2017, 48(8): 1819-1824.

1. 吴浩俊, 何艳霞, 陈航, 等. 髋臼后壁软骨面平行角重建螺钉置入安全性的CT扫描图像分析. 中国临床解剖学杂志, 2018, 36(4): 440-444.
2. Tosounidis TH, Giannoudis VP, Kanakaris NK, et al. The Kocher-Langenbeck approach: state of the art. J JBJS Essent Surg Tech, 2018, 8(2): e18.
3. Harnroongroj T, Riansuwan K, Sudjai N, et al. Posterior acetabular arc angle of unstable posterior hip fracture-dislocation. Int Orthop, 2013, 37(12): 2443-2449.
4. Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res, 1980, (151): 81-106.
5. Ebraheim NA, Waldrop J, Yeasting RA, et al. Danger zone of the acetabulum. J Orthop Trauma, 1992, 6(2): 146-151.
6. Varga E, Dudas B, Tile M. Putative proprioceptive function of the pelvic ligaments: biomechanical and histological studies. Injury, 2008, 39(8): 858-864.
7. Goulet JA, Rouleau JP, Mason DJ, et al. Comminuted fractures of the posterior wall of the acetabulum. A biomechanical evaluation of fixation methods. J Bone Joint Surg (Am), 1994, 76(10): 1457-1463.
8. Schopfer A, DiAngelo D, Hearn T, et al. Biomechanical comparison of methods of fixation of isolated osteotomies of the posterior acetabular column. J Int Orthop, 1994, 18(2): 96-101.
9. 陈林, 张伟, 时珂, 等. 前后联合入路重建带及重建钢板治疗复杂髋臼骨折的疗效比较. 中国修复重建外科杂志, 2016, 30(6): 680-684.
10. 马爱国, 裴宝瑞, 庞智寅, 等. 锁定重建钢板应用于髋臼横行后壁骨折的生物力学研究. 中国修复重建外科杂志, 2016, 30(11): 1354-1357.
11. Wang H, Utku K, Zhuang Y, et al. Post wall fixation by lag screw only in associated both column fractures with posterior wall involvement. J Injury, 2017, 48(7): 1510-1517.
12. Mast J, Jakob R, Ganz R. Planning and reduction technique in fracture surgery. Berlin: Springer-Verlag, 1989: 54-56.
13. Rollmann MF, Holstein JH, Pohlemann T, et al. Predictors for secondary hip osteoarthritis after acetabular fractures-a pelvic registry study. J Int Orthop, 2019, 43(9): 2167-2173.
14. Boudissa M, Ruatti S, Kerschbaumer G, et al. Part 2: outcome of acetabular fractures and associated prognostic factors-a ten-year retrospective study of one hundred and fifty six operated cases with open reduction and internal fixation. J Int Orthop, 2016, 40(10): 2151-2156.
15. Cahueque M, Martínez M, Cobar A, et al. Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?. J Clin Orthop Trauma, 2017, 8(4): 320-326.
16. Pascarella R, Cerbasi S, Politano R, et al. Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture. J Injury, 2017, 48(8): 1819-1824.

Chinese Journal of Reparative and Reconstructive Surgery

Application of self-made spring plate for treatment of acetabular posterior wall fractures

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