Both-column acetabular fracture with the secondary unstable anterior pelvic ring treated by internal fixation with reconstruction titanium plate combined with trans-plate quadrilateral screws via the ilioinguinal approach

LIN Guan-lin; CHEN Zhuang-hong; CAI Xian-hua; LIU Xi-ming; WANG Hua-song; ZHANG Bao-cheng

doi:10.3969/j.issn.1009-4237.2016.04.003

Abstract：Objective To explore the clinical efficacy of internal fixation using reconstruction titanium plate combined with trans-plate quadrilateral screws in the treatment of both-column acetabular fracture with unstable anterior pelvic ring on the other side via the ilioinguinal approach .Methods Of the 115 patients with acetabular fractures treated between Jan .2007 and Jan.2013,there were 19 cases with both-column fracture and unstable ante-rior pelvic ring on the other side according to Judet Letournel's classification.Of the 19 cases,8 were dual-column fracture,5 were T-shaped,3 were transverse and 3 were anterior column with transverse fracture .There were 12 males and 7 females,with an average age of 35.6 years(from 21 to 58 years).Eleven were injured from traffic acci-dent,5 from bruise and 3 from high falling.Three were associated with hemorrhagic shock ,3 with rib fracture and hemopneumothorax , 4 with limbs fracture ,1 with lumbar vertebral compression fractures ,2 with closed abdominal in-juries and 1 with traumatic brain injury .All the fractures were treated with internal fixation using reconstruction tita-nium plate combined with 3 to 5 transplate conical screws ( quadrilateral screws ) via the ilioinguinal approach after reduction.In some cases,the fixation was conducted via the bone surface .The quality of reduction was evaluated u-sing the Matta’s radiologic scoring system,while the hip functional recovery was evaluated using the modified Merle d’Aubignéand Postel scoring system at the last follow up .Results All patients received follow-up of 12 to 36 months(average,18.3months).According to Matta’s radiologic scoring system,ten patients achieved excellent ana-tomical reduction ,seven with good functional reduction and two with dissatisfactory reduction . All the patients a-chieved fracture healing after 2 to 6 months(average,3.8 months).In terms of functional recovery according to the modified Merle d’Aubignéand Postel scoring system,12 patients were rated as excellent,4 as good,2 as fair and 1 as poor ,achieving an excellent and good rate of 84.2%.No loosening or breaking of screws happened at the follow-ups.Conclusion Intemal fixation using reconstruction titanium plate combined with transplate quadrilateral screws via ilioinguinal approach is an effective choice for the treatment of double-column fractures involving the anterior col-umn.But it is necessary to keep the secondary anterior pelvic ring stable in the first place .