Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Journal of Orthopaedic Surgery & Traumatology

Open Access 20-04-2024 | Acetabular Fracture | Original Article

Using calcaneal plates in fixation of comminuted posterior wall acetabular fractures with cranial or posterior extension: a prospective case series and novel technique

Authors: Mahmoud Fahmy, Ebeed Yasin, Mohamed Abdelmoneim

Published in: European Journal of Orthopaedic Surgery & Traumatology

Login to get access

Abstract

Background

This study aims to evaluate the outcomes of using calcaneal plate in fixation of comminuted posterior wall (PW) acetabular fractures especially that have cranial (dome) or posterior extension (posterior column edge), and to evaluate its safety. To our knowledge, this is the first study that utilizes this off label implant technique in fixation of such fracture.

Methods

Twenty-two patients enrolled in the study with a minimum follow up of one year. After reducing the PW fragments sequentially, calcaneal plate was applied, fixing its distal part at ischial tuberosity upper ends using 3 screws in a triangular fashion, while its proximal part and radial wings were firmly fixed along the acetabular rim together with the classic longitudinal anchorage. Any fixation failure or head subluxation was recorded.

Results

Radiological outcome showed 18 cases scored as excellent, 2 were good, and 2 were poor. The functional outcome revealed 2 patients were excellent, 6 were very good and 14 were good. There was no loss of reduction or fixation failures throughout the follow up period.

Conclusion

Calcaneal plate may offer an alternative method of fixation of comminuted PW fractures with acceptable radiological and functional results. Our study result may encourage the comprehensibility and replicability of this practice, however randomized multicentered studies should be conducted to validate this assumption. This method provides valuable trick strategy, stable and soft-tissue-friendly fracture fixation where modern implantations may be unavailable or of high cost. Calcaneal plates show some fascinating features that allow using them outside their field being flexible with large footprint area for fracture buttressing beside numerous hole choices with diverse paths providing suitable fixation, articular stability and wide zone of coverage in PW comminuted fracture patterns with cranial or posterior extensions. The plate proximal triangular configuration together with distal triangular screw fixation gives a stiff rigid anchorage and buttressing similar to a metal mesh covering and fixing any fragment numbers up to dome level.
Literature
1.
2.
Moed BR, Carr SEW, Watson JT (2000) Open reduction and internal fixation of posterior wall fractures of the acetabulum. Clin Orthop Relat Res 1976–2007(377):57–67CrossRef
3.
Rollmann MF, Holstein JH, Pohlemann T et al (2018) Predictors for secondary hip osteoarthritis after acetabular fractures—a pelvic registry study. Int Orthop 43:2167–2173CrossRefPubMed
4.
Pascarella R, Cerbasi S, Politano R, Balato G, Fantasia R, Orabona G, Mariconda M (2017) Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture. Injury 48(8):1819–1824CrossRefPubMed
5.
Goulet JA, Rouleau JP, Mason DJ, Goldstein SA (1994) Comminuted fractures of the posterior wall of the acetabulum: a mechanical evaluation of fixation methods. J Bone Joint Surg Am 76A:1457–1463CrossRef
6.
Zhang Y, Zhao X, Tang Y, Zhang C, Xu S, Xie Y (2014) Comparative study of comminuted posterior acetabular wall fracture treated with the acetabular tridimensional memory fixation system. Injury 45(4):725–731CrossRefPubMed
7.
Lee C, Johnson EE (2018) Use of spring plates in fixation of comminuted posterior wall acetabular fractures. J Orthop Trauma 32:S55–S59CrossRefPubMed
8.
Askam B, Sims S (2019) Supplemental superior buttress plating for the treatment of posterosuperior wall acetabulum fractures. J Orthop Trauma 33:S27–S31CrossRefPubMed
9.
Lee AK, Wagner BR, McPhillips K, Horwitz DS, Widmaier JC Jr (2017) Locking compression pilon plate for fixation of comminuted posterior wall acetabular fractures: a novel technique. J Orthop Trauma 31(1):e32–e36CrossRefPubMed
10.
Olson SA, Bay BK, Chapman MW, Sharkey NA (1995) Biomechanical consequences of fracture and repair of the posterior wall of the acetabulum. J Bone Joint Surg Am 77:1184–1192CrossRefPubMed
11.
Moed BR, Willson Carr SE, Watson JT (2002) Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg Am 84:752–758CrossRefPubMed
12.
Dean D, Moed B (2009) Late salvage of failed open reduction and internal fixation of posterior wall fractures of the acetabulum. J Orthop Trauma 23(3):180–185CrossRefPubMed
13.
Firoozabadi R, Hamilton B, Toogood P, Shearer D (2018) Risk factors for conversion to Total hip arthroplasty after acetabular fractures involving the Posterior Wall. J Orthop Trauma 32(12):607–611CrossRefPubMed
14.
Saterbak AM, Marsh JL, Nepola JV, Brandser EA, Turbett T (2000) Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma 14(4):230–237CrossRefPubMed
15.
Giannoudis P, Tzioupis C, Moed B (2007) Two-level reconstruction of comminuted posterior-wall fractures of the acetabulum. J Bone Joint Surg Br 89(4):503–509CrossRefPubMed
16.
Ebraheim NA, Patil V, Liu J, Sanford CG, Haman SP (2007) Reconstruction of comminuted posterior wall fractures using the buttress technique: a review of 32 fractures. Int Orthop 31(5):671–675CrossRefPubMed
17.
Ziran BH, Little JE, Kinney RC (2011) The use of a T-plate as “spring plates” for small comminuted posterior wall fragments. J Orthop Trauma 25:574–576CrossRefPubMed
18.
Richter H, Hutson JJ, Zych G (2004) The use of spring plates in the internal fixation of acetabular fractures. J Orthop Trauma 18(3):179–181CrossRefPubMed
19.
Schwab JM, Zebrack J, Schmeling GJ, Johnson J (2011) The use of cervical vertebrae plates for cortical substitution in posterior wall acetabular fractures. J Orthop Trauma 25(9):577–580CrossRefPubMed
20.
Cho JW, Chung HJ, Kim BS, Yeo DH, Song JH, Oh CW et al (2019) Fragment specific fixation technique using 2.7 mm VA LCP for comminuted posterior wall acetabular fractures: a novel surgical technique. Arch Orthop Trauma Surg 139(11):1587–1597CrossRefPubMed
21.
Abo-Elsoud M (2021) Kassem Fragment-specific fixation of posterior wall acetabular fractures. Int Orthop 45:3193–3199CrossRefPubMed
22.
Hussain Z, Parmeshwar SS, Jain A, Chandra A (2023) Use of calcaneal plates in the treatment of posterior pelvic ring injuries and displaced iliac blade fractures-A case series. J Clin Orthop Trauma 37:102091CrossRefPubMed
23.
Pires RE, Giordano V, Boni G, Campos TV, Lopes MT (2021) de Andrade MA () Expanding the indications for calcaneal plates beyond foot fractures: a technical trick and case series. Eur J Orthop 31:2757–2782
Metadata
Title
Using calcaneal plates in fixation of comminuted posterior wall acetabular fractures with cranial or posterior extension: a prospective case series and novel technique
Authors
Mahmoud Fahmy
Ebeed Yasin
Mohamed Abdelmoneim
Publication date
20-04-2024
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-024-03939-1