From heel to hip: medial buttressing for quadrilateral plate fractures of the acetabulum with a locking calcaneal plate
DOI:
https://doi.org/10.64575/rxq4kx52Keywords:
Quadrilateral plate, calcaneus plate, acetabulum fractures, quadrilateral surface, spring plate, medial buttressingAbstract
Background: Complex acetabular fractures involving the quadrilateral plate (QLP) present significant surgical challenges due to poor bone quality, the inherent thinness of the QLP, and the proximity of significant neurovascular structures. While modern anatomical plates exist, their high cost and limited accessibility remain barriers. This study evaluates a novel, cost-effective surgical technique using a locked titanium calcaneus plate combined with a suprapectineal reconstruction plate for medial buttressing.
Methods: A total of 60 patients treated for acetabular fractures between 2016 and 2025 were reviewed. Ten patients specifically underwent medial buttressing for QLP fractures. Among these, five patients received a locked titanium calcaneus plate fixed to a suprapectineal reconstruction plate. Clinical and demographic data, fracture classifications (Letournel and Judet), and postoperative reduction quality (measured via CT scans) were analyzed. Reduction was categorized as anatomical (< 2 mm) or non-anatomical (≥ 2 mm).
Results: The mean age was 39.5 ± 16.1 years. Posterior wall fractures were the most common elementary pattern (60.6%), while anterior column with posterior hemitransverse fractures predominated the complex group (37%). Postoperative CT scans showed anatomical reduction in 83.3% of the total cohort. The mean follow-up was 11.5 months. The surgical approach was predominantly Kocher-Langenbeck (60%), followed by the modified Stoppa (30%) and ilioinguinal (10%) approaches.
Conclusion: Combining a locked titanium calcaneus plate with a suprapectineal reconstruction plate is a viable and effective alternative for stabilizing complex QLP fractures. This technique provides stable medial support using widely available implants, making it a good option in clinical settings where patient-specific or modern anatomical plates are unavailable.
References
1. Freude T, Gänsslen A, Krappinger D, Lindahl J. Quadrilateral plate fractures. Arch Orthop Trauma Surg. 2024;145(1):51. doi:10.1007/s00402-024-05698-4
2. Stein MG, Barmeir E, Levin J, Dubowitz B, Roffman M. The medial acetabular wall: normal measurements in different population groups. Invest Radiol. 1982;17(5):476-478. doi:10.1097/00004424-198209000-00007
3. Qureshi AA, Archdeacon MT, Jenkins MA, Infante A, DiPasquale T, Bolhofner BR. Infrapectineal plating for acetabular fractures: a technical adjunct to internal fixation. J Orthop Trauma. 2004;18(3):175-178. doi:10.1097/00005131-200403000-00009
4. Zha GC, Tulumuhan DM, Wang T, Wan GY, Wang Y, Sun JY. A new internal fixation technique for acetabular fractures involving the quadrilateral plate. Orthop Traumatol Surg Res. 2020;106(5):855-861. doi:10.1016/j.otsr.2019.09.026
5. Wu YD, Cai XH, Liu XM, Zhang HX. 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?. Clinics (Sao Paulo). 2013;68(7):1028-1033. doi:10.6061/clinics/2013(07)22
6. Wang W, Cai X, Liu X, Wang G, Kang H, Qian S. Special contoured pelvic brim reconstruction titanium plate combined with trans-plate buttress screws (quadrilateral screws) for acetabular fractures with quadrilateral plate involvement through the anterior ilioinguinal approach. Front Surg. 2024;11:1438036. doi:10.3389/fsurg.2024.1438036
7. Yang Y, Zou C, Fang Y. A study on fracture lines of the quadrilateral plate based on fracture mapping. J Orthop Surg Res. 2019;14(1):310. doi:10.1186/s13018-019-1318-3
8. Hutt JR, Ortega-Briones A, Daurka JS, Bircher MD, Rickman MS. The ongoing relevance of acetabular fracture classification. Bone Joint J. 2015;97-B(8):1139-1143. doi:10.1302/0301-620X.97B8.33653
9. Wan Y, Yao S, Ma Y, et al. The novel infra-pectineal buttress plates used for internal fixation of elderly quadrilateral surface involved acetabular fractures. Orthop Surg. 2022;14(8):1583-1592. doi:10.1111/os.13327
10. White G, Kanakaris NK, Faour O, Valverde JA, Martin MA, Giannoudis PV. Quadrilateral plate fractures of the acetabulum: an update. Injury. 2013;44(2):159-167. doi:10.1016/j.injury.2012.10.010
11. Boni G, Pires RE, Sanchez GT, Dos Reis FB, Yoon RS, Liporace FA. Use of a stainless steel locking calcaneal plate for quadrilateral plate buttress in the treatment of acetabular fractures. Eur J Orthop Surg Traumatol. 2019;29(5):1141-1145. doi:10.1007/s00590-019-02413-7
12. Demir MA, Sarıaslan AY. Demographic and clinical profiles of elementary versus associated acetabular fractures: insights from a single-center study. J Multidiscip Orthop Surg. 2025;1(2):27-32. doi:10.64575/t82bn688
13. Sen RK, Tripathy SK, Aggarwal S, Goyal T, Mahapatra SK. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach. Injury. 2013;44(2):266-273. doi:10.1016/j.injury.2012.11.002
14. Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg. 1999;7(2):128-141. doi:10.5435/00124635-199903000-00006
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