OTA 2002 Posters

Associated Anterior Column Fractures of the Acetabulum with Comminution

Volkan B. Guzel, MD; Allen Criswell, MD; Jeffrey Tucker, MD; Kevin J. Coupe, MD; Alan Rechter, MD; Rosemary Buckle, MD; University of Texas, Department of Orthopaedics, Houston, Texas, USA

Purpose: The anterior column of the acetabulum is involved in a variety of fracture patterns, as described by Letournel. It represents a challenge when there is comminution, especially in the older patient with osteoporosis. We report preliminary results of the application of a medial buttress plate to perform indirect reduction and internal fixation of the associated anterior column fracture with comminution.

Methods: We retrospectively reviewed the charts of 245 patients with acetabulum fractures treated surgically between January 1995 and December 1999 at a single institution. Of these, 37 patients (15%) had comminuted fractures involving the anterior column. The fractures were subgrouped according to the Letournel classification system. Limited ilioinguinal and Kocher-Langenbeck surgical approaches were used. A prebent, t-shaped medial buttress plate was incorporated into the standard pelvic rim plate through a common screw hole after indirect reduction was performed with the assistance of the buttress plate and an off-set king-tong reduction clamp. Preoperative and postoperative radiographs obtained at 3 months were evaluated. Maximum displacement on all views and joint space height measurements were made.

Results: Eleven female and 26 male patients with a mean age of 41 were included in the study. All 37 patients had comminuted anterior column fractures extending to the quadrilateral plate. Fifteen ilioinguinal approaches and 22 single-stage, combined ilioinguinal and Kocher-Langenbeck approaches were performed. Average preoperative displacement was 21.8 mm (range, 6 to 45 mm); postoperative displacement was 1.7 mm (range, 0 to 8 mm). Secondary joint congruity was restored in all patients. Joint space height was greater than 95% when compared with the contralateral side at 3 months.

Discussion. When anterior column fractures are comminuted, there is usually involvement of the quadrilateral plate, which is characterized by a thin layer of cortical bone. Internal fixation with screws and plate at this location is almost impossible because of the poor bone stock and difficult anatomy.

Conclusion: Indirect reduction of the fracture and stabilization with a buttress plate in combination with already known internal fixation methods is a viable option for the treatment of this particular fracture pattern.