Subcutaneous anterior pelvic bridge - an innovative technique for fixation of selective acetabular fracture: a case series and literature review

Abstract

Introduction: The aim of the study was to introduce an innovative technique involving the use of a subcutaneous anterior pelvic bridge (SAPB) in the treatment of selective acetabular fractures.

Methods: We performed a retrospective study of 21 patients with acetabular fracture who were treated with SAPB between January 2016 and March 2021. The patients' data were retrieved from electronic charts. Radiological results were evaluated according to the Matta system to assess the quality of the reduction and time of union. Functional outcomes were assessed in line with the d'Aubigné and Postel scoring system. Post-operative complications were also recorded.

Results: SAPB required around 60 minutes, with minimal blood loss and short learning curve. Matta score revealed excellent radiological outcomes in seventeen displaced fractures with seven excellent outcomes and nine good outcomes. Functional outcomes were excellent in twelve hips, good in seven hips, and fair in two hips. Six patients had transient lateral femoral cutaneous nerve palsy.

Discussion: The innovative SAPB method for the treatment of selective acetabular fracture is proven to be a feasible method with promising outcomes. SAPB is a minimally invasive technique and strengthens the stability of fixation, with less blood loss and fewer intra-operative/post-operative complications.

Keywords: Acetabular fracture; Anterior pelvic internal fixation; Minimally invasive; Pelvic bridge technique; Percutaneous anterior pelvic bridge; Subcutaneous anterior pelvic bridge.

Fig. 1

a Anterior wall fracture 62A3.1 (no. 16). b Left very low anterior column fracture 62A3.3 (no. 17). c Transverse fracture 62B3.3 (no. 1). d Both column fracture 62C1 (no. 9). e Non-displaced acetabular fracture 62A3.1 (no. 20)

Fig. 2

a Pre-bending of the plate to fit onto the iliac crest and contralateral pubic tubercle. b Skin incision and wound deepened superficial to abdominal fascia. c Subcutaneous tunnel created between iliac crest and pubic symphysis. d Postoperative image after 6 months of plate implantation

Fig. 3

a Post-operative radiographs of a 28-year-old man (no. 9) showing right iliac wing fracture, right acetabular both column fracture, left superior and inferior pubic rami fracture, pubic symphysis diastasis, and bilateral femoral open fracture showing anatomical reduction. b AP radiographs after removal of SAPB showing excellent radiological outcome with excellent functional outcome

Fig. 4

a Pre-operative AP radiographs of a 60-year-old woman with history of left THR (no. 4), showing left low anterior column fracture with right saddle type pubis fracture and sacral zone II fracture. b Post-operative AP radiograph showing anatomical reduction. c AP radiographs after removal of implants showing poor radiological outcome on right side pubic ramus but excellent radiological outcome on left hip

Fig. 5

a Post-operative Judet view radiographs of a 52-year-old man (no. 7) showing reduction of left ilium wing, left acetabular (two-column) central complex fracture with dislocated left hip joint and split femoral head fracture. b Pelvis AP and Judet view radiographs after 3 months of surgery showing signs of avascular necrosis and subcapital fracture. e AP radiograph after total hip replacement and removal of SAPB showing excellent radiological outcome but fair functional outcome