Oblique-ilioischial plate technique: a novel method for acetabular fractures involving low posterior column

Developing a core outcome set for acetabular fractures: a systematic review (part I)

BACKGROUND

There are indications that clinical studies investigating the surgical treatment of acetabular fractures assess different outcomes. This heterogeneity reduces the comparability of study results and, thus, limits the knowledge generated from research. Core outcome sets (COS) contain a minimum set of outcomes that should be measured in studies investigating a specific disease or injury. A COS for surgically treated acetabular fractures does not yet exist. Therefore, the aim of this study is to identify the reported outcomes in studies investigating the surgical treatment of acetabular fractures.

METHODS

Studies including skeletally mature individuals (≥ 16 years) with isolated acetabular fractures treated surgically were included. Studies with polytrauma patients, pathological fractures, additional pelvic fractures, exclusively non-surgical treatment, or juvenile individuals were excluded. Three databases and two clinical trial registries were searched on 15 November 2022. The identified outcomes were grouped and subsequently categorized according to the Core Outcome Measures in Effectiveness Trials Guidelines.

RESULTS

A total of 193 studies were included, which reported a cumulative total of 2581 outcomes. After grouping, 266 unique outcomes were identified. No outcome was examined in all studies. Pain, ability to walk independently, range of motion, quality of reduction, and heterotopic ossification were the most reported unique outcomes and assessed in at least 60% of included studies. A total of 105 outcomes were only assessed in one of the included studies. Outcomes of all five core areas and 25 outcome domains of the Core Outcome Measures in Effectiveness Trials taxonomy were examined. Furthermore, outcomes were named and defined differently, measured at different time points, and assessed using a variety of measurement instruments.

CONCLUSION

Overall, this systematic review shows that a wide range of outcomes are measured in studies examining surgical treatment of acetabular fractures. The results of this systematic review will be used in a subsequent study to develop the COS for surgically treated acetabular fractures by using the Delphi method.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42022357644; COMET: 2123.

Optimizing surgical management of acetabulum fractures involving both columns using buttress plating of posterior column through AIP approach

Introduction

Acetabulum fractures involving both columns are complicated injuries to treat, and achieving satisfactory post operative reduction with less extensile approaches is difficult. These injuries often require dual approaches, associated with their own share of complications. The anterior intrapelvic approach (AIP) addresses both columns through a single approach, minimizing these complications. Specifically, posterior column fixation is of utmost importance. This study aims to evaluate functional outcomes and complications of posterior column fixation using medial surface buttress plate in fractures involving both columns.

Materials and methods

Between 2017 and 2024, 366 patients had fractures involving both columns, out of which 64 were operated using the AIP approach. Excluding patients with displaced posterior wall fractures, transverse fractures, delayed treatment, or aged under 18 years. Out of 64, we collected data from 60 patients, as 4 patients could not be followed up. All patients were operated using the AIP approach, and posterior column fixation was done using 3.5 mm reconstruction plates. Patients were followed for minimum 6 months-70 months, with an average of 29 months. The associations between variables and functional outcomes were examined using the Chi-Square Test or Fisher's Exact Test.

Results

The study included 60 patients, with 48.3 % under 40 years old and 51.7 % older. Males comprised 68.3 % of the cohort. 46.7 % sustained road traffic accidents and 53.3 % had fall from height. T-type fractures were most common (50.0 %), with high posterior column fractures in 66.7 % of patients. Post-operative reductions less than 1 mm were achieved in 80.0 % of patients. Functional outcomes using the Harris hip Scores were found to be excellent to good in 90.0 % of patients.

Conclusion

We conclude that medial surface buttress plating of the posterior column using the standard AIP approach can be utilised to treat even the most complex of acetabular fracture patterns involving both anterior as well as posterior columns, excluding those that contain a displaced posterior wall.

Medial surface plating of posterior column through the anterior intrapelvic approach in acetabulum fractures with involvement of both columns

Aims

Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures.

Methods

We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d'Aubigné score and Matta's radiological grading at one year and at latest follow-up.

Results

Immediate postoperative radiological Matta's reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d'Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta's radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d'Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta's radiological grading at latest follow-up also remained unchanged.

Conclusion

Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window.