Minimally invasive plate osteosynthesis of acetabular anterior column fractures using the two-incision minimally invasive approach and a preshaped three dimension plate

Abstract

Purpose: To investigate the treatment of acetabular anterior column fractures using a two-incision minimally invasive (TIMI) approach and minimally invasive plate osteosynthesis (MIPO) technique using a preshaped 3D plate.

Methods: A group of 12 consecutive cases of acetabular fractures from March 2013 to July 2014 were treated with the TIMI approach. 3D mirror models of the uninjured side of the hemipelvis were printed preoperatively; the plates used in surgery were preshaped according to these models. MIPO surgical techniques were applied. All patients had a minimum one year radiographic and clinical follow-up.

Results: Seven fractures involved the anterior column, four were anterior column with posterior hemitransverse, and one was anterior column with the pubic symphysis. The average surgery time was 200 minutes, and mean blood loss was 1004 ml. The fracture reduction results as assessed by Matta radiographic outcome scores were good in eight, satisfactory in three, and poor in one patient. Functional outcomes according to the Harris hip scores were excellent for seven, good for three, and fair for two. Post-operative complications included incomplete femoral nerve damage and abdominal cavity injury.

Conclusions: The TIMI approach is an alternative to the ilioinguinal approach for anterior column acetabular fracture treatment, especially for fractures involving the dome and quadrilateral plate that are feasible for application of MIPO techniques. The technique of preshaping the 3D plate makes the plate better accommodated to the fracture surface and easier to apply in MIPO procedures. All dissection was between the anatomical interval, which allowed less soft tissue injury and related complications, and caused less bleeding. The fracture types in our case series were relatively simple, and follow-up time was short; more clinical trials are necessary for evaluation of middle- and late-term results.

Keywords: 3D-print; Acetabular fractures; MIPO; TIMI.