Abstract
BackgroundAcetabular fractures are relatively common, but management of the ischial fragment is a considerable problem when determining whether to use only the anterior approach or to add the posterior approach for anterior column and posterior hemitransverse acetabular fractures, T-type fractures, and both column fractures. This study is the first to demonstrate how to screw or drill around the quadrilateral space, posterior column, posterior wall, and near the ischial tuberosity from the anterior approach by a novel "sleeve guide technique". MethodsFirst, a nozzle, drill, depth gauge, and driver were prepared from DepuySynthes. Periosteum of the internal obturator muscle was detached from the quadrilateral plate to near the ischial tuberosity, while paying attention not to injure Alcock’s canal. The skin was cut about 1.5 cm opposite to the side of the fracture, and the nozzle was inserted as an external sleeve. Drilling, measuring screw length, and screwing were performed through this nozzle. With this technique, the approach angles of drilling and screwing to the posterior wall and ischium were inclined, and plating from the ischium to the ilium could be performed from the anterior approach. ResultsTwo cases are presented. Case 1 was a 63-year-old man who had a left both column fracture with a free bone fragment of the joint surface. After plating a 14-hole plate from the pubis to the ilium, a bent 14-hole plate was placed at the quadrilateral space as a buttress, and a screw was inserted from the posterior wall to the ilium using sleeve guide technique. Case 2 was a 66-year-old man with a quadrilateral fracture. After a 13-hole plate was bent and placed at the quadrilateral space, screws were inserted to the ischium and posterior wall using sleeve guide technique ConclusionsSleeve guide technique is very easy, useful, and safe to drill and insert screws to the quadrilateral space, posterior wall, and near the ischial tuberosity from the anterior approach. This technique can be used for simple drilling and screwing of a small T buttress plate held by a ball spike at the quadrilateral space from the surgical window. We believe that these techniques lead to new strategies for acetabular fractures.
Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?
