Novel utilization of H-plates in treatment of posterior wall components of acetabular fractures.

OBJECTIVES

To analyze outcomes of posterior wall acetabular fracture fragments fixed with the Synthes non locking 5 hole hind/midfoot plates (H-plates) in comparison to previously described methods. The hypothesis is that H-plates provide comparable outcomes to other fixation methods.

METHODS

DESIGN

Retrospective review

SETTING

Level 1 Trauma Center (2018-2023) PATIENT SELECTION CRITERIA: Adult patients with an acetabular fracture (AO/OTA 62) that underwent open reduction and internal fixation (ORIF) of a posterior wall component with free screws, spring plates or H plates. Patients with <3 months follow up were excluded.

OUTCOME MEASURES AND COMPARISON: Primary outcomes included conversion to total hip arthroplasty (THA), revision ORIF, all other reoperations, and dislocations. Secondary outcomes included surgical site infection (SSI) and mortality. Outcomes were compared between fixation with H plate, Spring plate and screws.

RESULTS

Of 343 patients, 102 (29.7 %) had fixation of posterior wall fracture components with H plates. The average age was of 38.7 (18-84), with 69.7 % being males and follow up of 250 days (90-972). When comparing H plates with all other fixation methods there were no significant differences with regards to rates of THA conversion (5.9 % vs 11.6 %, P = 0.104), revisions (0 vs 0.8 %, P = 0.356) or reoperations (3.9 % vs 4.1 %, P = 0.922). When comparing H plates, spring plates, and independent screws as separate groups for fixation, THA conversion rate was lower with H plates (5.3 % vs 16.7 % vs 10.4 %, P = 0.042). Revision fixation (0.0 % vs 0.0 % vs 1.9 %;p = 0.017) and reoperations (4.2 % vs 4.4 % vs 2.8 %, P = 0.810) were not significantly different. Age (OR1.105, p < 0.001), spring plate (OR 11.63, p < 0.001 and free screw use (OR 4.2, p = 0.028) increased risk for THA conversion.

CONCLUSION

H-plate use was associated with lower rate of conversion to total hip arthroplasty compared to other fixation options. Future prospective research should focus on evaluating the outcomes of different fixation choices for acetabular fractures with posterior wall components.

LEVEL OF EVIDENCE: III.