Wei Wang ^1,2 Xianhua Cai ^1,3 Ximing Liu ^1* Guodong Wang ¹ Hui Kang ¹ Shenglong Qian ¹

• ¹ General Hospital of Central Theater Command, Wuhan, China
• ² Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei Province, China
• ³ South China Hospital of Shenzhen University, Shenzhen, China

Background: Managing complicated acetabular fractures involving the quadrilateral plate (QLP) can be challenging for surgeons, especially when complicated by comminution and osteoporosis. The primary purpose of this study is to introduce a novel technique that utilizes a special contoured pelvic brim reconstruction titanium plate combined with quadrilateral screws to reduce and stabilize acetabular fractures involving the QLP through the ilioinguinal approach. Additionally, the secondary purpose is to evaluate both clinical effectiveness and radiological outcomes of this technique for QLP fractures.Methods: 48 patients who were suffered from acute displaced fractures of the QLP and treated using a special contoured plate combined with quadrilateral screws between January 2012 and December 2019. All patients including 31 males and 17 females. The mean age was 47.56±11.31 years. Immediate postoperative reduction quality was evaluated according to Matta's criteria. Final clinical functions were assessed during follow-up using the modified Merle d’Aubigné and Harris Hip scores.Results: All 48 consecutive patients had relatively satisfactory clinical treatment effectiveness. Average follow-up time, operation time, and intraoperative blood loss were 48.36±12.94 months, 246.08±54.30 minutes, and 715.16±263.84 ml, respectively. According to the Matta scoring system, 30 cases of reduction were graded as excellent, 14 as good, and four as fair. At the last follow-up, the clinical outcome evaluation was excellent in 26 cases, good in 17 cases, fair in four cases and poor in one with the use of the modified Merle d’Aubigné-Postel scoring system. The average Harris Hip Score was 87.38 ± 7.86(ranging from 52 to 98). Postoperative lateral femoral cutaneous nerve injury occurred in two patients, delayed wound healing and subsequent development of an inguinal hernia in one patient. One patient of heterotopic ossification and another patient of posttraumatic osteoarthritis underwent hip arthroplasty within two years after surgery. Conclusion: Our results indicate that employing the contoured plate specifically designed for the QLP injuries, in conjunction with quadrilateral screws through the ilioinguinal approach, can lead to positive outcomes in the treatment of displaced acetabular fractures involving the QLP. This straightforward and efficient technique offers a viable option for surgeons who are managing complex acetabular fractures.