Efficacy of horizontal plate plus raft screws above the acetabulum in the treatment of acetabular fractures combined with dome impaction in the aged patients
Objective To compare the efficacy of the horizontal plate plus raft screws above the acetabulum and fixation with screws only for acetabular fractures combined with dome impaction in the aged patients.Methods A retrospective cohort study was conducted to analyze the clinical data of 20 aged patients with acetabular fractures combined with dome impaction,who were admitted to Tianjin hospital between May 2013 and January 2023,including 5 males and 15 females,aged 61-84 years[(72.2±7.3)years].According to Letournel and Judet classification,13 patients had anterior column fracture,5 anterior column fracture combined with posterior transverse fracture and 2 two-column fracture.All the patients underwent open reduction and internal fixation through an anterior approach.Of them,11 patients were treated with the fixation with the horizonal plate plus raft screws above the acetabulum(plate plus raft screw group)and 9 with the screws only(screw only group).The operative time,intraoperative blood loss,and intraoperative fluoroscopy times were compared between the two groups.The quality of fracture reduction was evaluated with the Matta's radiographic criteria at 3 days after surgery and the function of the hip joint was assessed with Merle D'Aubigné and Postel scoring system at 3 months after surgery and at the last follow-up as well as the excellent and good rate at te last follow-up.The occurrence of postoperative complications was observed.Results All the patients were followed up for 6-18 months[(13.1±3.1)months].There were no significant differences in the operative time,intraoperative blood loss or intraoperative fluoroscopy times between the two groups(P＞0.05).According to the Matta's radiographic criteria at 3 days after surgery,patients with anatomical reduction and satisfactory reduction accounted 6 and 5 in the plate plus raft screw group,compared to 5 and 4 respectively in the screw only group(P＞0.05).The values of Merle D'Aubigné and Postel score at 3 months after surgery and at the last follow-up were(14.0±2.4)points and(15.8± 2.2)points in the plate plus raft screw group,which were higher than those in the screw only group[(11.0± 2.6)points and(13.0±3.l)points](P＜0.01).The values of Merle D'Aubigné and Postel score at the last follow-up of both groups were further enhanced from those at 3 months after surgery(P＜0.01).At the last follow-up,3 patients were rated excellent,6 good,1 fair and 1 poor in the plate plus raft screw group,with an excellent and good rate of 81.8％,while in the screw only group,3 were rated good,2 fair and 4 poor,with an excellent and good rate of 33.3％(P＜0.05).One patient in the plate plus raft screw group and 5 in the screw only group had displacement of the dome impaction fragment combined with traumatic arthritis after surgery(P＜0.05).Conclusion For acetabular fractures combined with dome impaction in the aged patients,the horizontal plate plus raft screw above the acetabulum can effectively improve the function restoration of the hip joint and reduce the occurrence of the displacement of the dome impaction fragment and traumatic arthritis after surgery compared to the fixation with screws only.
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