The effect of an infra-acetabular screw for anatomically shaped three-dimensional plate or standard plate designs in acetabulum fractures: a biomechanical analysis

Background Various plate shapes and implant configurations are used for stabilization of acetabulum fractures via anterior approaches. Little is known about the biomechanical stability of a two-dimensionally shaped “conventional” plate (“J-Plate”—JP) in comparison to three-dimensionally shaped plate configurations (3DP). In addition, the augmentary effect of an infra-acetabular lag-screw (IACS) fixation for anterior column and posterior hemi-transverse acetabulum fractures has not been clarified in comparison of JP and 3DP constructs. This study analyzed the difference between the biomechanical stability of JP compared to 3DP and the role of an IACS in a standardized acetabular fracture model in a single-leg stance loading configuration. Methods In an artificial bone substitute pelvis model (Synbone© Malans, Switzerland), a typical and standardized fracture pattern (anterior column and posterior hemi-transverse) was created with osteotomy jigs. After anatomic reduction the stabilization was performed using JP or 3DP. Eight pelvises per group were axially loaded in a single-leg stance model up to 400 N. After the load cycle, an additional infra-acetabular screw was placed and the measurement repeated. Fragment displacement was recorded by an optical tracking system (Optitrack Prime 13®, Corvallis, USA). Results In the pure placement, 3DP provided significantly superior stability when compared to JP. Augmentation of JP by IACS increased the stability significantly, up to the level of 3DP alone, whereas augmentation of the 3DP did not result in further increase of overall stability. Conclusion The anatomically shaped plate alone provides a superior biomechanical stability in fixation of an anterior column and posterior hemi-transverse fracture model. In a JP fixation the augmentation by IACS provides similar strength as the anatomically shaped 3DP. By use of the anatomically shaped 3DP the need of a clinically risky application of IACS might be avoidable. Level of evidence IV, Experimental study.

Complex fracture pattern involving ipsilateral intertrochanteric fracture associated with ipsilateral posterior hip dislocation and posterior acetabular wall fracture: A rare combination of injuries

Introduction:High-energy trauma has increased the incidence of traumatic hip dislocation. In most cases, dislocation of the hip is associated with fractures of the acetabulum. However, its association with ipsilateral intertrochanteric fracture is very rare. Case Report:We present a case of a 54-year-old male who had uncommon fracture pattern involving ipsilateral intertrochanteric femur fracture associated with ipsilateral posterior fracture dislocation of hip following a road traffic accident. He underwent closed reduction of the dislocation followed by an open reduction and internal fixation of the fractures. Through Kocher-Langenbeck approach, the intertrochanteric fracture was reduced and fixed with dynamic hip screw and derotation anti-rotation screw. Acetabulum fractures then fixed after reduction with two reconstruction plates. Conclusion:Early recognition and orthopedic intervention constitute the cornerstones of satisfactory outcomes in cases with such complex injuries. Keywords:Posterior hip dislocation, acetabular fractures, intertrochanteric fracture.