Custom-made locked plating for acetabular fracture: a pilot study in 24 consecutive cases

Clinical implementation of site-specific locking plates for acetabular fracture remains untested. Custom-made locking plates were manufactured using computer-aided design and computer-aided manufacture techniques for acetabular fractures to test this procedure. The 3-dimensional images constructed from computed tomography data of pelvises in patients with acetabular fractures were used for preoperative planning and to design the plates. Data for each plate were input into software for programming, and the generated code was transferred into a computerized numerical control digital milling machine for manufacturing. These plates were clinically implemented, and the implementation parameters, reduction quality, and Postel Merle d'Aubigné score were evaluated. Forty-nine custom-made locking plates were manufactured for 24 unilateral acetabular fractures. The manufacturing process for the plates averaged 6.9±2.2 days. Processing the plates delayed operations by 2.6±1.3 days in one-third of the cases. Plate contouring was avoided in 48 plates. The plates had anatomical shapes, excellently matching reduced bone surface. The screws locked with the obtained plates avoided intra-articular penetration and provided secure fixation that allowed early out-of-bed rehabilitation. No indications of implant failures or observations of screw back-outs were observed during follow-up. The clinical application of such plates is associated with the avoidance of plate contouring, low risk of intra-articular penetration, early out-of-bed rehabilitation, and a low rate of implant failure. Implementing such plates in clinical practice is worthy of further investigation, with a focus on selecting patient population and minimizing the time required for and cost of plate manufacturing.