Clinical outcomes of internal iliosciatic fixation using a conventional reconstruction plate via an anterior approach for acetabular fractures involving the posterior column.

backgroundAcetabular fractures involving the posterior column remain surgically challenging because of the complex three-dimensional anatomy and restricted operative corridor. As an alternative to traditional posterior approaches, internal iliosciatic fixation through an anterior approach has gained increasing acceptance. Reconstruction plates, which offer the advantages of low cost and convenient intraoperative bending, are extensively used in clinical settings.

methodsA retrospective case series was conducted on 36 consecutive patients with acetabular fractures involving the posterior column who underwent internal iliosciatic fixation using an intraoperatively contoured reconstruction plate between July 2019 and November 2022. The modified Stoppa approach (n = 26) or the pararectus approach (n = 10) was employed. Fracture reduction was assessed using the modified Matta criteria, and hip function was evaluated using the modified Merle d'Aubigné-Postel score at one-year follow-up. Operative time, blood loss, fracture union, and complications were recorded.

resultsThe mean age of the patients was 42.6 ± 14.5 years (range: 21-71 years), with 25 males and 11 females. Mechanisms of injury included traffic accidents (n = 21), falls from height (n = 10), skiing injuries (n = 3), and others (n = 2). According to the Letournel-Judet classification, there were 13 both-column fractures, 11 anterior column posterior hemitransverse (ACPHT) fractures, 9 T-shaped fractures, and 3 transverse fractures. The mean operative time was 108 ± 31 min (range: 70-180 min), and mean intraoperative blood loss was 430 ± 120.9 mL (range: 200-1100 mL). Fracture reduction was rated as excellent in 27 patients (75%), good in 5 (14%), and fair in 4 (11%). At a mean follow-up of 14.4 ± 3.2 months (range: 12-24 months), the Merle d'Aubigné-Postel score was excellent in 26 patients (72%), good in 7 (19%), and fair in 3 (8%). All fractures achieved union, with a mean healing time of 3.7 months. Complications included transient obturator nerve injury in three patients (all resolved within three months) and incisional fat liquefaction in two obese patients. No deep infection, implant failure, or heterotopic ossification was observed.

conclusionInternal iliosciatic fixation using a conventional reconstruction plate via an anterior approach yields satisfactory fracture reduction and functional outcomes in patients with acetabular fractures involving the posterior column or quadrilateral plate. This technique is reliable and cost-effective, making it particularly suitable for resource-limited settings where pre-contoured anatomical plates or 3D-printed implants are not readily available.