Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Maintenance of Reduction...

Background Acetabular fractures with quadrilateral plate involvement have been shown to have a high rate of complications. Anatomic suprapectineal plating systems have been developed to manage these injuries with good short-term outcomes. However, long-term maintenance of anatomical reduction and functional outcomes has yet to be established. The aim of this study is to maintain reduction and functional outcomes at a minimum of five years of follow-up. Materials and methods This is a retrospective cohort study from a prospective database examining patients aged over 16 years following fixation of acetabular fractures with quadrilateral plate involvement at a trauma center in the United Kingdom. All patients had acetabular fracture fixation with an anatomically designed suprapectineal plate. Patients were admitted from March 2014 to January 2017. Primary outcomes included objective radiological outcomes such as reduction quality, maintenance of reduction, and subjective patient-related outcome measures (PROMs) using the Oxford Hip Score (OHS) and EuroQol EQ5D Score at a minimum of five years post-operatively. Secondary outcomes recorded included metalwork failure and complications such as reoperation, neurological deficit, and mortality. Results 16 patients met our eligibility criteria in this cohort. Post-operative mean OHS at a minimum of five years was 40.5 (SD=11.9), with a median score of 45. Post-operative mean EuroQol EQ-5D scores at a minimum of 5 years were 0.83 (SD=0.25). Radiographic outcomes were assessed with AP and Judet plain radiographs at a minimum of five years follow-up. Preoperatively, 56.3% (9) showed evidence of dome comminution, with 18.8% (3) demonstrating dome impaction. 93.7% (15) had quadrilateral plate involvement. 12.5% (2) showed evidence of femoral head injury. The rate of conversion to total hip replacement was 6.25% (1) at 15 months post-injury. Conclusions Maintenance of reduction and functional and patient-reported outcomes of patients who underwent open reduction and internal fixation of an acetabular fracture using anatomically contoured suprapectineal plates have satisfactory radiological and functional outcomes at five-year follow-up.