Self-made one-fourth tubular hook plate for fixation of comminuted fractures of acetabular posterior wall

Objective To observe the clinical efficacy of self-made one-fourth tubular hook plate used in the fixation of comminuted fractures of acetabular posterior wall. Methods The clinical data of 21 patients with comminuted fracture of acetabular posterior wall were retrospectively analyzed who had been treated by fixation with our self-made one-fourth tubular hook plate from June 2015 to September 2017 at Deparment I of Orhthopaedics, The Second People's Hospital of Anhui Province. They were 12 males and 9 females, aged from 20 to 59 years (mean, 38.5 years). The time from injury to surgery ranged from 3 to 6 days (average, 4.5 days). All the fractures were fixated with our self-made one-fourth tubular hook plate via the Kocher-langenbeck approach. Depending on the fracture fragments, the hook plate was cut out obliquely through the 3rd or 4th hole and the sharp end of the plate was bent into a small hook to hold the fragments. Only the hook plate was used in 6 cases and an additional construction plate in the other 15 cases. The postoperative reduction, functional recovery of the affected hip and complications were recorded. Results The follow-up averaged 13 months (from 8 to 32 months). Intermuscular venous thrombosis occurred in one patient and sciatic nerve contusion was observed intraoperatively in one patient with sciatic nerve injury. According to the improved Matta criteria, the fracture reduction was rated as excellent in 16 cases, as good in 4 and as poor in one, giving a good to excellent rate of 95.2%. The fractures united after an average of 7.5 months (from 6 to 12 months). According to the improved Merle d'Aubigne and Postel scoring system, the hip function at the final follow-up was excellent in 14 cases, good in 3, fair in 2 and poor in 2, giving a good to excellent rate of 81.0%. Follow-ups revealed traumatic arthritis in 3 cases, femoral head necrosis in 2 cases and ectopic ossification in one. Conclusion Our self-made one-fourth tubular hook plate is simple, economical and effective because it can provide easy and rigid fixation of the comminuted fractures of acetabular posterior wall, leading to fine therapeutic effects. Key words: Acetabulum; Fractures, comminuted; Fracture fixation, internal; Bone plates