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. 2021 Jun;33(6):1627-1633.
doi: 10.1007/s40520-020-01682-1. Epub 2020 Sep 9.

Internal fixation of acetabular quadrilateral plate fractures in elderly patients: Could the fracture reduction quality affect their functional recovery?

Antonello Panella  1 , Giuseppe Solarino  1 , Giovanni Vicenti  2 , Davide Bizzoca  1 , Marco Baglioni  1 , Francesco Fortunato  1 , Francesco Maruccia  1 , Angela Notarnicola  1 , Andrea Piazzolla  1 , Raffaele Pascarella  3 , Alberto Belluati  4 , Biagio Moretti  1
Affiliations

Internal fixation of acetabular quadrilateral plate fractures in elderly patients: Could the fracture reduction quality affect their functional recovery?

Antonello Panella et al. Aging Clin Exp Res. 2021 Jun.

Abstract

Background: Osteoporotic acetabular fractures frequently involve the quadrilateral plate (QP), a flat and thin bone constituting the medial wall of the acetabulum. This study aims to assess the impact of the quality of osteoporotic QP fractures reduction on the patients' functional recovery, at 24 months follow-up.

Methods: Patients referring with osteoporotic QP fractures to our Level I trauma centre were prospectively recruited.

Inclusion criteria: patients aged 60 years old or older; osteoporosis, defined as Dual-energy X-ray Absorptiometry (DXA) T-score ≤ - 2.5; acute acetabular fracture; anatomic or good fracture reduction according to Matta on postoperative CT.

Exclusion criteria: moderate cognitive impairment (defined as Mini-Mental State Examination < 19); a history of malignant neoplasm; concomitant fractures in other sites; traumatic head injury; lower limb joint prostheses; patient not able to walk independently before trauma; poor fracture reduction, according to Matta, on postoperative CT. All the QP fractures were surgically managed. After surgery, the reduction of each QP fracture was classified as anatomical (displacement 0-1 mm), good (displacement 2-3 mm) and poor (displacement > 3 mm) on postoperative CT. Based on this classification: patients with a poor fracture reduction were excluded from this study, patients with an anatomical reduction were recruited in Group-A and patients with a good reduction in Group-B. All the patients underwent a clinical and radiographic 24-months follow-up.

Results: 68 patients (males 38; females 30; mean age 68.6 years old; range 60-79) were finally included in in the study. No cases of open fractures or concomitant pelvic ring fractures were observed. Based on the post-operative CT, 39 patients showed an anatomic fracture reduction (Group-A) while the remaining 29 patients revealed a good fracture reduction (Group-B). Complication rates and mean clinical scores showed no significant differences between groups, at 24-months follow-up.

Conclusions: In this study, the functional recovery at 24 months follow-up showed no significant differences in elderly patients with QP fracture undergoing anatomical reconstruction (displacement 0-1 mm) compared to patients receiving a good QP fracture reconstruction (displacement ≤ 3 mm).

Keywords: Acetabular fracture; Elderly fracture; Functional recovery; Harris hip score (HHS); Quadrilateral plate; Quality of reduction; WOMAC.

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Conflict of interest statement

All authors declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
A 61 years old man reported, in a car accident, a left hemitransverse + anterior column acetabular fracture. a Preoperative X-rays: AP view and Judet views. b Preoperative CT. c Postoperative X-rays. d X rays at 24 months follow-up
See this image and copyright information in PMC

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