Percutaneous osteosynthesis of acetabular fractures with quadrilateral plate involvement using an infra-pectineal plate through a new paramedial approach: Description of the technique using cadaveric specimens

Abstract

Percutaneous osteosynthesis of acetabular fractures with quadrilateral plate involvement using an infra-pectineal plate through a new paramedial approach using cadaveric specimens.

Background: Intrapelvic approaches and infrapectineal plates have been used since the mid-nineties to solve Quadrilateral Plate osteosynthesis, with some problems in applying screws in the correct direction and difficulty in fracture reduction. We describe a minimally invasive paramedial approach and new ways to fix infrapectineal plates using one-step osteosynthesis (reduction and fixation).

Methods: Four transverse and four posterior hemitransverse acetabular fractures were reproduced using four fresh frozen cadavers. Acetabular osteosynthesis was performed using the paramedial approach. Sequential lasting time and reduction/stability quality were measured using analysis of variance (ANOVA) with Bonferroni Correction as the statistical method, registering iatrogenic injuries.

Results: Osteosynthesis was performed on seven acetabulae using infrapectineal horizontal plates for transverse fractures and vertical plates for posterior hemitransverse fractures. The duration of incision was 3:08 min and osteosynthesis was 55:12 min, with a total of 58:29 min. Median fracture displacement of 13.25 mm turned to a median of 0.01 mm once fracture osteosynthesis was performed with a p = 0.017. The peritoneum was injured twice and good osteosynthesis stability was observed.

Conclusion: The paramedial approach is safe with direct access to key anatomical structures for acetabular osteosynthesis. Infrapectineal with reverse fixation plate osteosynthesis provides an excellent reduction rate and good stability once the implants act against displacement forces, making it possible to direct them freely. Further clinical and biomechanical trials are required to confirm our findings. We believe that there was an improvement of up to 60% in the result quality for some cases; however, this technique must be compared with other techniques. Evidence Level IV (Experimental Trial).

Keywords: Acetabular fractures; Infrapectineal plate; Paramedial approach; Percutaneous osteosynthesis; Quadrilateral plate; Reverse fixation.