Temporary titanium plate screwing in open reduction and internal fixation for displaced acetabular fracture

Objective To explore the efficacy of temporary titanium plate screwing for positional maintenance in reduction and internal fixation for displaced acetabular fractures. Methods A retro-spective study was conducted of the 28 patients (28 hips) with displaced acetabular fracture who had been treated by open reduction and internal fixation from October 2013 to March 2016. They were 20 males and 8 females, aged from 24 to 68 years (average, 42.3 years). The time from injury to surgery ranged from 7 to 21 days(average, 14.5 days). According to the Letournel-Judet classification, there were 2 posterior column fractures, 4 transverse fractures, 5 posterior column plus posterior wall fractures, 6 transverse plus posterior wall fractures, 2 T-shaped fractures, 3 anterior and posterior transverse fractures and 6 double column fractures. The posterior acetabular approach or combined anterior and posterior approach was used. In all the patients temporary titanium plate screwing was conducted to fix one side of the fracture so as to facilitate accomplishment of open reduction and internal fixation without losing the indirect anatomic reduction of the in-traarticular fracture. After the open reduction and internal fixation was accomplished, the temporary screw fixation was removed in 26 patients but retained in 2 patients as needed. The reduction quality, complications and outcomes at the final follow-ups were recorded. Results All the 28 patients were followed up for 10 to 36 months (mean, 15.6 months). By the Matta criteria, anatomical reduction was achieved in 26 cases, unsatisfactory reduction in one and poor reduction in one, yielding an anatomic reduction rate of 92.9%. By the improved Merle d’Aubigne & Postel criteria, the clinical outcomes at the final follow-up were excellent in 27 cases and good in one, yielding a good to excellent rate of 100%. Postoperatively, heterotopic ossification of different severities occurred in 11 cases but did not affect their joint function; transient paralysis of the sciatic nerve was reported in 6 cases but recovered 3 months after surgery. No complications like avascular necrosis of the femoral head or walking pain were observed during follow-ups. Conclusion Temporary fixation with titanium plate screws during open reduction and internal fixation for displaced acetabular fractures can effectively improve the reduction and fixation of the articular surface, leading to satisfactory short-term clinical outcomes. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Bone nails