Using calcaneal plates in fixation of comminuted posterior wall acetabular fractures with cranial or posterior extension: a prospective case series and novel technique

Abstract

Background: This study aims to evaluate the outcomes of using calcaneal plate in fixation of comminuted posterior wall (PW) acetabular fractures especially that have cranial (dome) or posterior extension (posterior column edge), and to evaluate its safety. To our knowledge, this is the first study that utilizes this off label implant technique in fixation of such fracture.

Methods: Twenty-two patients enrolled in the study with a minimum follow up of one year. After reducing the PW fragments sequentially, calcaneal plate was applied, fixing its distal part at ischial tuberosity upper ends using 3 screws in a triangular fashion, while its proximal part and radial wings were firmly fixed along the acetabular rim together with the classic longitudinal anchorage. Any fixation failure or head subluxation was recorded.

Results: Radiological outcome showed 18 cases scored as excellent, 2 were good, and 2 were poor. The functional outcome revealed 2 patients were excellent, 6 were very good and 14 were good. There was no loss of reduction or fixation failures throughout the follow up period.

Conclusion: Calcaneal plate may offer an alternative method of fixation of comminuted PW fractures with acceptable radiological and functional results. Our study result may encourage the comprehensibility and replicability of this practice, however randomized multicentered studies should be conducted to validate this assumption. This method provides valuable trick strategy, stable and soft-tissue-friendly fracture fixation where modern implantations may be unavailable or of high cost. Calcaneal plates show some fascinating features that allow using them outside their field being flexible with large footprint area for fracture buttressing beside numerous hole choices with diverse paths providing suitable fixation, articular stability and wide zone of coverage in PW comminuted fracture patterns with cranial or posterior extensions. The plate proximal triangular configuration together with distal triangular screw fixation gives a stiff rigid anchorage and buttressing similar to a metal mesh covering and fixing any fragment numbers up to dome level.

Keywords: Calcaneal plate; Fixation; Posterior wall.

Fig. 1

Saw bone and its radiograph demonstration showing 3 ischial screws can be inserted in a triangular pattern at the ischial tuberosity upper end together with the V shape anchorage of the proximal part of the plate

Fig. 2

Saw bone demonstration showing calcaneal plate application with large footprint area to cover all expected posterior wall fragments and case examples radiograph

Fig. 3

A 3D CT scan of 41 year-old male patient showing comminuted PW fracture of the left hip. B, C, D Postoperative radiograph (AP and Judet views) after calcaneal plate fixation showing anatomically reduced fracture. E Postoperative CT (axial cuts) after fixation showing anatomical reduction. F, G, H 1 year radiographs (AP and Judet views) show stable fixation with no reduction loss or fixation failure

Fig. 4

A 3D CT scan of 46 year-old male patient showing comminuted PW fracture of the left hip. B, C, D Postoperative radiograph (AP and Judet views) after calcaneal plate fixation showing anatomically reduced fracture. E CT (axial cuts) after fixation showing anatomical reduction. F 1 year radiographs show stable fixation with no reduction loss or fixation failure