How to Solve Anatomical Mismatch in Fixation of Acetabular Fractures Using an Anatomical Quadrilateral Surface Plate

Abstract

The anatomical quadrilateral surface buttress plate developed for the quadrilateral surface in an acetabular fracture, a type of fracture difficult to reduce using screws and plates due to its thinness, is a useful implant that makes surgical treatment easier. However, the anatomical structure is different for each patient, and it often does not match the contour of this plate, making detailed bending difficult. Here, we introduce a simple method for controlling the degree of reduction using this plate.

Keywords: Acetabulum; Bone plate; Fractures; Reduction.

Fig. 1. Suprapectineal type quadrilateral surface plate (Stryker, Selzach, Switzerland).

Fig. 2. Three-dimensional reconstruction images of computed tomography of a 59-year-old male patient. (A) On preoperative three-dimensional computed tomography, an acetabular fracture with displaced quadrilateral surface and superior dome of the hip joint was observed. (B) On the oblique view, there were several fragments in the fracture site.

Fig. 3. Images for surgical procedures. (A) An acetabular fracture with displaced quadrilateral surface and superior dome of the hip joint was observed. (B) The unicortical drilling was performed in the mismatching area between the bony contour and the plate. (C) A 3.5-mm cortical screw with a washer was inserted. If the needed length of a screw was shorter than the minimum provided length, cutting a screw into a proper length would be required. A fine adjustment of compression can be done by adding an additional washer in this step. (D) We cut the 5.0-mm cannulated screw short and tied it with a nonabsorbable suture. The screw was inserted into the hole of the quadrilateral surface (QLS) plate in the opposite direction of the screw insertion. Then, the fracture site and screw were pressed with the QLS plate and a ball spike.

Fig. 4. Surgical procedures. (A) After unicortical drilling at the most displaced portion of the acetabular superior dome, we inserted a 3.5-mm cortical short cut screw with washers. (B) We cut the 5.0-mm cannulated screw short and tied it with Vicryl. (C) The screw was inserted into the hole of the quadrilateral surface (QLS) plate in the opposite direction of the screw insertion. (D) The state of reduction was confirmed by pressing the QLS plate to the fracture site.

Fig. 5. Immediate postoperative radiographs. (A) An immediate postoperative pelvic anteroposterior radiograph. (B) A three-dimensional reconstruction computed tomography (CT) image. (C) An axial CT view showing the heads of screws (white arrows) pushing the displaced fragments by the quadrilateral surface (QLS) plate. (D) A coronal view CT showing anatomical reduction achieved and the head of screw (white arrow) pushing the displaced fragment by the QLS plate.