A novel anatomical titanium plate versus the reconstruction plate for quadrilateral plate fractures of the acetabulum: A propensity-matched cohort study

Background Because of the peculiar anatomy and complex geometry of this region, surgical treatment of acetabular fractures involving quadrilateral plate is a challenge to orthopaedic surgeons. Many scholars consider that quadrilateral plate exist a absolute “dangerous zone” for screw placement and have designed a variety of buttress plates to control medial displacement of the quadrilateral surface. In order to achieve the safe and effective fixation in quadrilateral plate, we have developed a novel fixation technique using a special shaped reconstruction plate combined with several buttress screws of quadrilateral plate which was called Dynamic Anterior Plate-Screw System for Quadrilateral plate (DAPSQ) since 2005(RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, a set of anatomical titanium plate(ATP group) of DAPSQ have been designed and applied for the treatment of quadrilateral plate fractures. The aim of this study was to compare the efficacy of anatomical titanium plate versus the reconstruction plate in the treatment of quadrilateral plate fractures. Methods We led a propensity-matched cohort study of quadrilateral plate fractures, and twenty-two patients were treated with anatomical titanium plate of DAPSQ in the inclusion period(2016-2018), and were matched to 22 cases in our database of RP group(2008-2016). The primary outcome measures were quality of reduction and functional outcome. Intraoperative conditions included surgical time, bleeding, and blood transfusion and the postoperative complications were also compared. Results Of these 22 consecutive patients in ATP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture(12cases, 54.5%) according to Letournel-Judet classification. The mean follow up period was 23.1 months (range 12-37). There was no significant differences between the two groups with regards the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d’Aubigné score(P>0.05). Compared with the RP group, the ATP group has a short operation time(245.1 minutes vs. 286.8 minutes, P = 0.020), less intraoperative blood loss(1136.4 mL vs. 1777.3mL, P = 0.014) and transfusion(780.9 vs. 1256.8mL, P = 0.035). The complication rate was 22.7% in ATP group, and there was no significantly difference compared with the RP group(54.5%)(P>0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure. Conclusions The fixation of anatomical titanium plate in quadrilateral plate fractures showed similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. But the utility of anatomical titanium plate had the advantages of shorter operation time, less bleeding and transfusion which is worthy to recommend.