Quadrilateral plate fractures of the acetabulum treated by internal fixation with reconstruction titanium plate combined with trans-plate quadrilateral screws via the ilioinguinal approach

Objective To explore the clinical efficacy of internal fixat.ion using reconstruction tita- niulll plate combined with trans-plate quadrilateral screws in treatment of quadrilateral plate fractures of the acetabulum via the ilioinguinal approach. Methods Of the 52 quadrilateral plate fractures of the ac-etahululTl which had been treated between January 2005 and May 20川, 36 cases were followed up. They were 21 males and 15 females, with an average age of 43.5 years （from 21 to 59 years）. By Letournel＇s classifi- cation, there were 15 double-column fractures, d transverse ones, 8 anterior column plus posterior he- mi-transverse ones and 9 T-shaped ones. All the fractures were treated with internal fixation using recon- struction titanium plate combined with 3 to 5 trans-plate cortical screws （so-called quadrilateral screws） via the ilioinguinal approach after the fracture reduction. In some, fixation was conducted via the bone surface. The quality of reduction was evaluated using the Matta＇s radiologic scoring system whilst the hip functional recovery using the modified Merle d＇ Aubign6 and Postel scoring system. Results The duration of follow-up was 12 to 72 months （average, 41.7 months） . Nineteen patients achieved anatomical reduction, 12 patients func- tional reduction and 5 patients dissatisfactory reduction, giving an excellent and good rate of 86. 1%. All the patients achieved fracture healing after 2 to 4 months （average, 3 months）. In terms of functional recovery, 16 patients were rated as excellent, 13 as good, 5 as acceptable and 2 as poor, giving an excellent and good rate of 80.6%. The rate of excellent and good recovery was positively related to the quality of the fracture reduction （ r = 0.513, P = 0. 001 ）. No loosening or breaking of screws happened at the follow-ups. Conclusion In- ternal fixation using reconstruction titanium plate combined with trans-plate quadrilateral screws via ilioinguinal approach is an effective choice for treatment of double-column fractures chiefly involving the anterior column, transverse factures with anterior displacement, some anterior column plus posterior hemi-transverse fractures and some T-shaped fractures because there is no risk of screws penetrating into the joint cavity. Key words: Acetabulum;  Fractures;  Fracture fixation, internal;  Bone plate