USAPAP for treatment of posterior acetabular fractures

Objective To evaluate the clinical efficacy of universal self-locking anatomical plate for acetabulum and pelvis (USAPAP) in the treatment of posterior acetabular fractures. Methods Data of 55 patients with posterior acetabular fractures who were treated with the USAPAP from January 2014 to January 2016 were retrospectively analyzed. There were 39 males and 16 females with an average age of 38.5 years old (range, 17-82 years). There were 35 fractures on the left side while the other 20 fractures were on the right side, including 52 fresh cases and 3 old cases. According to Letournel-Judet classification, there were 32 cases of posterior wall, 9 cases of transverse and posterior wall, 5 cases of anterior column and posterior wall, 2 cases of posterior column, 2 cases of transverse, 2 cases of two columns, 1 case of anterior column and posterior hemitransverse, 2 cases of Pipkin type IV. All patients were managed operatively by the USAPAP, which allows simultaneous fixation for two columns and quadrilateral surface fractures through a single Kocher-Langenback approach. The quality of reduction was assessed by Matta's score system. The mean follow-up period was 18.5 months (range, 12-24 months). Average operation time was 95 min, and average blood loss was 350 ml. Average operation time of plate and screws fixation was 19 min, and average fluoroscopy times in the surgery was 2 times. The mean time of bony union was 4.3 months. According to the criteria described by Matta, the excellent and good rate of radiological score was 92.7% (51/55), including 39 cases excellent, 12 cases good and 4 cases poor. The excellent and good rate of Merle d’Aubigne-Postel score was 87.3% (48/55), including 35 cases of excellent, 13 cases of good, 5 cases of fair, and 2 cases of poor. Heterotopic ossification occurred in 1 patient (Brooker type II) at three months postoperatively. One case with Pipkin type IV fracture underwent total hip arthroplasty due to femoral head necrosis at seven months postoperatively. Complications including wound infection, sciatic nerve injury, screw invade joint, redisplacement of the fracture, avascular necrosis of bone fragment, hardware failure, nonunion or malunion was not found in any case at the latest follow-up. Conclusion The USAPAP through the single posterior Kocher-Langenback approach provides strong and stable fixation for complex acetabular fractures associated with posterior region including posterior wall, both columns and quadrilateral surface. Satisfactory clinical results can be achieved by the use of this method. Key words: Acetabulum; Fractures, bone; Fracture fixation; Internal fixators