A novel anatomical titanium plate versus the reconstruction plate for quadrilateral plate fractures of the acetabulum: A propensity-matched cohort study
Background Surgical treatment of acetabular fractures involving quadrilateral plate is a challenge to orthopaedic surgeons. We have developed a novel fixation technique using a special shaped reconstruction plate combined with several buttress screws of quadrilateral plate which was also called Dynamic Anterior Plate-Screw System for Quadrilateral plate (DAPSQ) to treat acetabular fractures involving quadrilateral plate since 2005(RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, anatomical titanium plate (ATP group) of DAPSQ have been designed and applied. The aim of the study was to compare the clinical efficacy of anatomical plate and the reconstruction plate of DAPSQ in the treatment of quadrilateral plate fractures. Methods We led a propensity-matched cohort study of quadrilateral plate fractures. Twenty-two patients were included in the ATP group during 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 outcomes. Intraoperative conditions 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 were 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 shorter 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 18.2% in ATP group, and there was no significantly difference compared with the RP group (36.4%)( P > 0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure. Conclusion s The fixation of anatomical titanium plate in quadrilateral plate fractures showed a similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. The anatomical titanium plate of DAPSQ has the advantages of short operation time, less intraoperative bleeding and blood transfusion, and it is worth further promotion and research.