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Functional, radiological, and quality of life outcome of unstable acetabular fracture with quadrilateral plate involvement at a tertiary care center in Jakarta, Indonesia

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Unstable acetabular fracture remains a complex fracture that requires technically demanding surgery for orthopedic surgeons. Quadrilateral plate (QP) fractures of the acetabulum are a challenging group of acetabular fractures to manage. However, the literature regarding the management of these injuries are limited. The QP is a relatively thin medial wall of the acetabulum and intra-articular; thus, anatomical reduction and stable fixation are required for satisfactory outcome. This study aims to determine the functional, radiological, and quality of life outcome of unstable acetabular fracture with QP involvement.

Methods

This was a retrospective cohort study conducted at Cipto Mangunkusumo General Hospital during the period of 2010–2020. Patients with unstable acetabular fractures with and without QP involvement were included in this study. They were followed up postoperatively at 1, 6, and 12 months. Functional outcome was assessed using the Harris Hip Score (HHS), Merle D'Aubigne, and Oxford Hip Score (OHS); while radiology outcome was assessed using Matta Outcome Grading; and quality of life was assessed using the SF-36.

Results

This study involved 53 subjects with a median age was 29 (18–75) years of age. Twenty-eight (52.8%) subjects had unstable acetabular fracture with QP involvement. Twenty-five (47.2%) subjects had unstable acetabular fracture without QP involvement. Twenty-five (47.2%) subjects were fixed using quadrilateral hook plate, 3 (5.7%) with infrapectineal plate, 10 (18.8%) with posterior column plate, and 15 (28.3%) with suprapectineal plate. The median intraoperative bleeding in those with unstable acetabular fracture with QP involvement was 600 (300–4000) ml, which was higher than those without QP involvement (400 [100–1700] ml). Those with QP involvement achieved anatomical reduction in 20 (71.4%) subjects. Whereas, the subjects without QP involvement achieved anatomical reduction 23 patients (92%). Subjects with QP involvement had significantly lower functional, radiological, and quality of life outcomes compared to those without quadrilateral plate involvement based on Harris Hip Score (p = 0.046), Merle D'Aubigne (0.001), Oxford Hip Score (0.001), Matta Outcome Grading (0.004), and SF-36 (0.001). Patients with quadrilateral hook plate showed no significant functional, and radiological outcome difference compared to patients with infrapectineal plate based on Harris Hip Score (p = 0.582), Merle D'Aubigne (0.698), Oxford Hip Score (1.000), and Matta Outcome Grading (1.000). In addition, we also found no significant functional, radiological, and quality of life outcome difference between posterior column plate and suprapectineal plate group based on Harris Hip Score (p = 0.200), Merle D'Aubigne (0.643), Oxford Hip Score (0.316), Matta Outcome Grading (1.000), and SF-36 (0.600).

Conclusions

Patients with unstable acetabular fracture with quadrilateral plate involvement subject had significantly lower functional, radiological, and quality of life outcomes compared to those without quadrilateral plate involvement. Both quadrilateral hook and infrapectineal plates demonstrated non-significant functional and radiological outcomes difference. Posterior column plate also resulted in the same functional, radiological, and quality of life outcome compared with suprapectineal fixation.

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References

  1. Cheng EY, Bastian JD (2019) Selecting surgical approaches for treatment of acetabular fractures. JBJS Essent Surg Tech 9:e4

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ghosh S, Aggarwal S, Kumar V, Patel S, Kumar P (2019) Epidemiology of pelvic fractures in adults: our experience at a tertiary hospital. Chin J Traumatol 22(3):138–141

    Article  PubMed  PubMed Central  Google Scholar 

  3. ElNahal WA, Abdel Karim M, Khaled SA, Abdelazeem AH, Abdelazeem H (2018) Quadrilateral plate fractures of the acetabulum: proposition for a novel classification system. Injury 49(2):296–301

    Article  PubMed  Google Scholar 

  4. Burlew CC, Moore EE, Stahel PF, Geddes AE, Wagenaar AE, Pieracci FM et al (2017) Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma Acute Care Surg 82(2):233–242

    Article  PubMed  PubMed Central  Google Scholar 

  5. Caillot M, Hammad E, Le Baron M, Villes V, Leone M, Flecher X (2016) Pelvic fracture in multiple trauma: a 67-case series. Orthop Traumatol Surg Res 102(8):1013–1016

    Article  CAS  PubMed  Google Scholar 

  6. Giordano V, Koch HA, Gasparini S, Serrão de Souza F, Labronici PJ, do Amaral NP (2016) Open pelvic fractures: review of 30 cases. Open Orthop J 10:772–8

    Article  PubMed  PubMed Central  Google Scholar 

  7. Andrich S, Haastert B, Neuhaus E, Neidert K, Arend W, Ohmann C et al (2017) Excess mortality after pelvic fractures among older people. J Bone Miner Res 32(9):1789–1801

    Article  PubMed  Google Scholar 

  8. White G, Kanakaris NK, Faour O, Valverde JA, Martin MA, Giannoudis PV (2013) Quadrilateral plate fractures of the acetabulum: an update. Injury 44(2):159–167

    Article  PubMed  Google Scholar 

  9. Porter SE, Schroeder AC, Dzugan SS, Graves ML, Zhang L, Russell GV (2008) Acetabular fracture patterns and their associated injuries. J Orthop Trauma 22(3):165–170

    Article  PubMed  Google Scholar 

  10. Hoeksma HL, Van Den Ende CHM, Ronday HK, Heering A, Breedveld FC, Dekker J (2003) Comparison of the responsiveness of the Harris Hip Score with generic measures for hip function in osteoarthritis of the hip. Ann Rheum Dis 62(10):935–938

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ugino FK, Righetti CM, Alves DBPL, Guimarães RP, Honda EK, Ono NK (2012) Evaluation of the reliability of the modified merle d’Aubigné and postel method. Acta Ortop Bras 21(4):213–217

    Article  Google Scholar 

  12. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89(8):1010–1014

    Article  CAS  PubMed  Google Scholar 

  13. Wylde VV, Learmonth ID, Cavendish VJ (2005) The Oxford hip score: the patient’s perspective. Health Qual Life Outcomes 31:3

    Google Scholar 

  14. Mauffrey C, Hao J, Cuellar DO, Herbert B, Chen X, Liu B et al (2014) The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable? Clin Orthop Relat Res 472(11):3332–3337

    Article  PubMed  PubMed Central  Google Scholar 

  15. ElNahal WA, Abdel Karim M, Khaled SA, Abdelazeem AH, Abdelazeem H (2018) Quadrilateral plate fractures of the acetabulum: proposition for a novel classification system. Injury 49(2):296–301

    Article  PubMed  Google Scholar 

  16. Kulkarni CU, Sen A, Jose J (2019) Outcome analysis of surgical management of comminuted quadrilateral plate acetabulum fractures. Int J Res Orthop 5(5):883

    Article  Google Scholar 

  17. Panella A, Solarino G, Vicenti G, Bizzoca D, Baglioni M, Fortunato F et al (2021) Internal fixation of acetabular quadrilateral plate fractures in elderly patients: could the fracture reduction quality affect their functional recovery? Aging Clin Exp Res 33(6):1627–1633

    Article  PubMed  Google Scholar 

  18. Borg T, Berg P, Larsson S (2012) Quality of life after operative fixation of displaced acetabular fractures. J Orthop Trauma 26(8):445–450

    Article  PubMed  Google Scholar 

  19. Singh SV, Chopra RK, Puri G, Pheroz Sr M, Kumar Sr S, Bansal A, Sodhi SS (2020) Clinico-radiological evaluation of modified stoppa approach in treatment of acetabulum fractures. Cureus, 12(9)

  20. Briffa N, Pearce R, Hill AM, Bircher M (2011) Outcomes of acetabular fracture fixation with ten years’ follow-up. J Bone Joint Surg Br 93-B(2):229–36

    Article  Google Scholar 

  21. Trikha V, Das S, Aruljothi V, Chowdhury B (2020) Prospective evaluation of outcome of acetabular {Fractures} managed by anterior {Intrapelvic} {Approach}. Indian J Orthop 54(S2):228–238

    Article  PubMed  PubMed Central  Google Scholar 

  22. Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78(11):1632–1645

    Article  CAS  PubMed  Google Scholar 

  23. Jindal K, Aggarwal S, Kumar P, Kumar V (2019) Complications in patients of acetabular fractures and the factors affecting the quality of reduction in surgically treated cases. J Clin Orthop Trauma 10(5):884–889

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kistler BJ, Smithson IR, Cooper SA, Cox JL, Nayak AN, Santoni BG et al (2014) Are quadrilateral surface buttress plates comparable to traditional forms of transverse acetabular fracture fixation? Clin Orthop Relat Res 472(11):3353–3361

    Article  PubMed  PubMed Central  Google Scholar 

  25. Laflamme GY, Delisle J, Leduc S, Uzel PA (2009) Isolated quadrilateral plate fracture: an unusual acetabular fracture. Can J Surg 52(5):217–219

    Google Scholar 

  26. Deo SD, Tavares SP, Pandey RK, El-Saied G, Willett KM, Worlock PH (2001) Operative management of acetabular fractures in {Oxford}. Injury 32(7):581–586

    Article  CAS  PubMed  Google Scholar 

  27. Kulkarni CU, Sen A, Jose J (2019) Outcome analysis of surgical management of comminuted quadrilateral plate acetabulum fractures. Int J Res Orthop 5(5):883

    Article  Google Scholar 

  28. Pease F, Ward AJ, Stevenson AJ, Cunningham JL, Sabri O, Acharya M, Chesser TJS (2019) Posterior wall acetabular fracture fixation: a mechanical analysis of fixation methods. J Orthop Surg 27(3):2309499019859838

    Article  CAS  Google Scholar 

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Funding

This study was not funded by any institution or any individual.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

    Ardiansyah Ardiansyah, Ismail Hadisoebroto Dilogo, Bambang Gunawan & Ihsan Oesman

  2. Faculty of Medicine Universitas Brawijaya, Malang, Indonesia

    Djati Herlambang

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  1. Ardiansyah Ardiansyah
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  2. Ismail Hadisoebroto Dilogo
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  3. Bambang Gunawan
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  4. Ihsan Oesman
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Correspondence to Ardiansyah Ardiansyah.

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The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All the patients provided informed consent. Our institute's medical research ethics committee has already given this project approval (LB.02.03).

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Ardiansyah, A., Dilogo, I.H., Gunawan, B. et al. Functional, radiological, and quality of life outcome of unstable acetabular fracture with quadrilateral plate involvement at a tertiary care center in Jakarta, Indonesia. Eur J Orthop Surg Traumatol 34, 1131–1140 (2024). https://doi.org/10.1007/s00590-023-03752-2

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