Journal List > J Korean Fract Soc > v.29(1) > 1038067

Kang, Lee, and Lee: Usefulness of Spring Plate for Acetabular Posterior Wall Fracture Including Small Fragment

Abstract

Purpose

We applied internal fixation using a spring plate against an acetabular posterior wall fracture including small fragments and then evaluated the clinical and radiological results and want to understand the usefulness of the spring plate.

Materials and Methods

Fifteen patients in whom fixation was difficult using leg screws or a metal plate because of a small bone fragment, in patients with posterior wall acetabular fractures who presented in our hospital since August of 2011 to March of 2014 were enrolled. The mean age was 42.6 years (range 24-54 years) with relatively young patients, and they were followed-up for at least one year. We analyzed the rate of reduction after surgery using the classification of Matta in radiographs, and the classification of Borrelli in 3-dimensional computed tomography (CT) and clinical results were evaluated using the clinical grading system.

Results

There were five cases of anatomical reduction, 9 cases of imperfect reduction, and 1 case of unsatisfactory reduction according to the classification of Matta. Except for one case during the follow-up period, the union of bone was successful without failure of fixation and the clinical results were 6 cases of excellence, 8 cases of good, and 1 case of failure. Articular displacement was also evaluated in postoperative CT scan according to Borrelli's criteria. The mean of gap and step off was 2.04 mm, 1.3 mm.

Conclusion

Use of leg screw fixation and so on in posterior wall fractures including a small fragment of the acetabular rim is not easy. However the method using spring plate fixation enables relatively accurate reduction and fixation for a small fragment and the clinical outcome showed satisfactory results.

Figures and Tables

Fig. 1

(A) Making a spring plate. The tip of the plate is cut to make the hook shape. (B) Photograph of the spring plate.

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Fig. 2

A 37-year-old male with a left hip fracutre and dislocation with an acetabular posteior wall fracture. (A) Preoperative anterioposterior radiograph of the pelvis. (B) Preoperative three dimensional computed tomography scan. (C) The small bony fragment is observed in the acetabular posterior wall. (D) Postoperative anterioposterior radiograph of the pelvis. Applying the reconstruction plate and spring plate against the fracture site for reduction. (E) Postoperative computed tomography scan shows configuration of the spring plate. (F) The anterioposterior raidograph of the pelvis after 1 year.

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Table 1

Patient Demographics

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Case No. Age (yr)/sex Injury mechanism Type* Dislocation Comminution
1 26/male MVA G III +
2 31/female MVA A II
3 48/male MVA F - +
4 54/male MVA G - +
5 37/male MVA A II
6 54/male MVA F III +
7 53/male MVA A III +
8 55/female MVA A III +
9 28/male MVA A -
10 24/male F/D A -
11 55/male PA F - +
12 41/male F/D A III +
13 40/female PA A -
14 52/male MVA A II
15 46/male F/D A II

*Classification according to the standard of Judet and Letournel.

Classification according to the standard of Thompson and Epstein. MVA: Motor vehicle accident, F/D: Fall down, PA: Pedestrian accident.

Table 2

Quality of Reduction and Clinical Grading System (CGS)

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Case No. Fixation Duration of union Reduction Displacement* CGS Complication
1 Spring plate 16 Imperfect 5.5/1.7 Excellent -
3 cannulated screw
2 Spring plate 12 Anatomical 0/0 Excellent -
2 cancellous screw
3 Spring & reconstruction plate 23 Imperfect 2.8/2.9 Good -
Cannulated screw
4 Spring & reconstruction plate 20 Imperfect 0/0 Excellent -
5 2 spring & reconstruction plate 20 Imperfect 0.5/0.5 Good -
6 Spring & reconstruction plate 18 Imperfect 2.6/1.6 Excellent -
Cannulated screw
7 Spring & reconstruction plate - Poor 6/3 Poor Redislocation
Sciatic nerve palsy
8 Spring & reconstruction plate 21 Anatomical 0.8/1.5 Good -
Cannulated screw
9 Spring & reconstruction plate 12 Anatomical 0.6/1.3 Good -
10 Spring plate 12 Anatomical 0/0 Excellent -
11 Spring & reconstruction plate 18 Imperfect 2.5/1.9 Good -
Cannulated screw
12 Spring & reconstruction plate 20 Imperfect 2/1.5 Good -
13 Spring & reconstruction plate 13 Anatomical 0.9/0 Excellent -
14 Spring & reconstruction plate 16 Imperfect 1.7/1 Good -
15 Spring & reconstruction plate 15 Imperfect 2.6/2 Good -
Cannulated screw

*Step off/gap.

Table 3

Correlation between Congruency of Fracture and Functional Score*

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Mean±standard deviation t p-value
Anatomical 17.600±0.547 3.080 0.010
Excellent 15.66±1.322

*t-test.

Notes

Financial support This study was supported by research fund from Chosun University, 2014.

Conflict of interest None.

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