Evaluation of Surgical Approach on Reduction Quality for Transverse-Family Acetabulum Fractures

Evaluation of Surgical Approach on Reduction Quality for Transverse-Family Acetabulum Fractures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Surgical Approach on Reduction Quality for Transverse-Family Acetabulum Fractures Andrea Rincon, BS, Erik-Matthew, BS Sario, Aziz Saade, MD, Chiara Giordani, MS, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7553638/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Dec, 2025 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction: Given the variety of transverse acetabular fracture patterns, different approaches are used for surgical fixation. The purpose of this study is to determine the association between surgical approach and fracture pattern on reduction quality in patients with transverse-family acetabular fractures. Methods A retrospective review was performed on adult patients with transverse-family acetabular fractures undergoing surgical fixation at a level 1 trauma institution between 2017–2023. The primary outcome was reduction quality based on Matta’s criteria using postoperative computed tomography (CT) scans and X-rays. On CT scans, the greatest gap displacement and step-off was recorded in all three planes. On X-rays, gap displacement was measured on AP. Secondary outcomes included surgical complications. Results On review, 47 patients were included, 68.1% were male with a mean age of 40.1, and an average follow-up of 8 months. Fractures included 12 transverse (approaches: 58.3% anterior, 25% posterior, and 16.7% percutaneous), 26 TP wall (88.4% posterior, 3.8% combined anterior-posterior (AP), and 7.8% percutaneous), and 10 T-shape (approaches: 50% anterior, 20% posterior, 10% combined AP, and 20% percutaneous). Reduction was assessed on postoperative CT with a significant difference in preoperative (6.82 ± 6.64 cm) and postoperative (1.96 ± 1.93 cm) mean maximal displacement (p < 0.001). On CT scans, 19% had anatomic reductions, 65% had good reductions, and 16% had poor reductions. There was no significant difference in CT or X-ray quality reduction between surgical approaches, transverse-family fracture type, hip dislocation on presentation, and surgeon experience, respectively. Patients who were cigarette smokers were more likely to have complications and Matta’s grade of ‘(p = 0.003, = 0.003, respectively). Conclusion Although challenging, anatomic and good reductions can be achieved in transverse-family acetabular fractures. There were no observed differences in the quality of reduction or complication rates between different surgical approaches. Approaches for transverse-family acetabular fractures are predicated on careful fracture pattern assessment to determine surgical approach followed by technical execution. acetabulum fracture transverse reduction quality anterior approach posterior approach Figures Figure 1 Figure 2 Figure 3 Highlights No difference in reduction quality between surgical approaches for transverse-family acetabulum fractures. Introduction Transverse-family acetabular fractures are relatively uncommon, affecting approximately 3 per 100,000 people annually in the United States ( 5 , 15 ). The incidence of these fractures displays a bimodal age distribution, primarily affecting young (< 40 years) from high-energy trauma, or elderly adults from low-impact falls in setting of decreased bone density ( 16 , 18 ). The underlying pathophysiology of transverse-family acetabular fractures involves the impact of the femoral head against the curved articular surface of the acetabulum; however, the pattern varies by position of the hip at the time of impact. ( 18 ). Transverse-family acetabular fractures include transverse, transverse-posterior wall, and T-shape ( 4 , 19 ). The transverse component can be further subclassified based on location in relation to the weight bearing dome as transtectal, juxtatectal, or infratectal. These variable fracture patterns contribute to the complexity requiring thoughtful preop planning and surgical execution. Most of these acetabular fractures require open reduction and internal fixation (ORIF); however, there is no consensus on standard surgical approach based on fracture pattern. The most common surgical approaches include the modified ilioinguinal approach or the Kocher-Langenbeck approach (sometimes combined). While diverse fracture patterns warrant different approaches for repair, lack of an approach algorithm complicates decision-making and may hinder optimal outcomes in the treatment of acetabular fractures. Reduction of the articular surface and containment of the femoral head are critical for hip survivorship ( 5 , 18 ). Postoperative complications include posttraumatic arthritis and osteonecrosis, infection, iatrogenic nerve injury, deep vein thrombosis, and heterotopic ossification ( 18 ). Different surgical approaches carry different risks profiles in these fractures. The purpose of this study is to evaluate the association of surgical approaches for transverse-family acetabular fracture ORIF based fracture patterns and assess the resulting reduction quality. The secondary objective of this study is to identify factors contributing to malreduction and the incidence of postoperative complications. Patient and Methods Following Institutional Review Board approval, a retrospective study was conducted on patients who underwent surgery for transverse, transverse- posterior wall (TPW), and T-shaped acetabulum fractures at a single Level 1 trauma center over the 6-year period of 2017 to 2023. The T-shaped fractures were further classified based on the T-stem component in relation distally from the obturator foramen as anterior, posterior, or ischial. The transverse component for all subtypes was further classified into intratectal, juxtatectal, and transtectal. Inclusion criteria consisted of patients who underwent surgery for transverse-family acetabulum fractures who were 18 years of age or older and younger than 90 years of age at the time of surgery. The exclusion criteria included non-transverse-family acetabulum fractures, pregnant women, prisoners, and those with no preoperative and postoperative computed tomography (CT) and/or X-ray imaging. All surgeries were performed by fellowship-trained orthopaedic trauma surgeons at our institution. Electronic medical records were reviewed to obtain patient demographics, injury characteristics, surgery characteristics, postoperative follow-up complications, surgeon experience, mechanism of injury, pelvic injury and whether a hip dislocation was identified preoperatively. Operative notes were reviewed to categorize what surgical approaches were used including anterior ilioinguinal and/or anterior intrapelvic approach (ANT), the Kocher-Langenbeck (KL) posterior approach, a combination of the two (ANT + KL), or percutaneous screw fixation. Fracture types were classified using Judet and Letournal by operating surgeon. Reduction Quality All radiographic measurements were performed by a fellowship-trained orthopaedic trauma surgeon on CTs and radiographs. Initial displacement and postoperative reduction quality was determined by measuring maximal displacement and maximal step-off in axial, sagittal, and coronal on preoperative and postoperative CTs. Step-off measurements were completed by creating a circle to fit the acetabular dome and the center of that dome to the first point of step-off was measured using a ruler and a second line ruler started at that same center point to the second point of step-off, the difference between the two measurements was used as our main step-off measurement, a technique explained described by Verbeek et al.(Figs. 1 – 3 ). X-ray max displacement was measured preoperatively and postoperatively using the posterior wall or the dome of the acetabulum. For both CT and X-ray, max displacement was measured using the largest space across the acetabular dome. Using Matta’s criteria, each measurement was classified as “excellent” ( 3 mm). Statistical Analysis Statistical t-tests were used to compare the means of the two groups of preoperative and postoperative computed tomography reduction and preoperative and postoperative radiographs and presented as mean differences with 95% confidence interval (CI). Chi-squared and Fischer’s exact tests were used to compare categorical variables. A p-value less than 0.05 was statistically significant. Results In our review, 47 patients met inclusion criteria consisting of most commonly male (31/47) patients, with a mean age of 40.9 ± 19.1, and an average follow-up of 7.6 months. There were 12 transverse fractures with the following surgical approaches performed: 7 anterior, 3 posterior, and 2 percutaneous. There were 26 TPW fractures with the following surgical approaches performed: 23 posterior, 1 combined, and 2 percutaneous. There were 10 T-shape fractures with the following surgical approaches performed: 5 anterior, 2 posterior, 1 combined, and 2 percutaneous. The transverse fracture components were 31 transtectal, 14 juxtatectal and 3 infratectal (Table 1). Reduction was noted to varying degrees with an overall preoperative mean maximal displacement (6.82 ± 6.64 cm) decreasing on postoperative CT (1.96 ± 1.93 cm) for each fracture (p < 0.001). On CT scans, 37/48 had excellent reductions, 10/48 had good reductions and 1/48 had poor reduction (Table 2) (Table 3). There was no significant difference in CT or X-ray quality reduction between surgical approaches(p = 0.71; p = 0.06), transverse fracture component location (transtectal, juxtatectal, and infratectal) (p = 0.78; p = 0.43), fracture type (p = 0.65; p = 0.19), hip dislocation on presentation (p = 0.20; p = 0.44), and surgeon experience (p = 0.88; p = 0.10), respectively (Table 4, Table 5). A statistically significant association was identified between surgical approach and the type of transverse fracture component; transtectal, juxtatectal, or infratectal (p = 0.039; Table 6). One patient had bilateral fractures, computing a total of 48 fractures included in the analysis. No significant differences were determined for Matta’s grades for postoperative CT based on age, sex, diabetic status, alcohol use, BMI, polytrauma status, or ASA. However, zero of the 11 patients who reported a history of smoking had an “excellent” Matta’s grade (p = 0.003) on CT. Matta’s grades for postoperative X-ray were not significantly different across age, sex, diabetic status, smoking history, alcohol use, BMI, polytrauma status, or ASA. Complications occurred in 12 of the 48 procedures: 3 DVTs, 1 sciatic nerve palsy with Kocher-Langenbeck approach, and 1 patient with sepsis. Of the 48 fractures, 7 (transverse ( 2 ), TPW ( 3 ), T-shape ( 2 )) returned to the OR (3 anterior approach, 3 posterior approach, 1 combined approach, and 0 percutaneous approach) for revision surgeries (3 total hip arthroplasty, 3 debridement for deep infection, and 1 implant removal). The quality reduction in the three patients who underwent subsequent THA was assessed by postoperative imaging. Postoperative computed tomography (CT) demonstrated good reduction in two cases and poor reduction in one case. Postoperative radiographs showed excellent reduction in one case and good reduction in two cases. The intervals from initial open reduction and internal fixation (ORIF) to THA were 3 days, 11 months, and undetermined for the third patient. For the latter case, the patient's medical record contained a gap from 2018 to 2023; however, a CT scan obtained in September 2023 confirmed that a THA had been performed during this interval. Complication rates were not significantly different between surgical approaches (p = 0.20) (Table 2). Furthermore, no significant difference in complication rates was observed based on age, sex, diabetic status, alcohol use, BMI, polytrauma status, or ASA. Patients who reported cigarette smoking, however, were more likely to experience complications following the procedure, with 5 of the 11 patients who experienced complications reporting a history of smoking (p = 0.003). Discussion To our knowledge, this is the largest study to assess reduction quality in transverse-family acetabulum fractures when compared to surgical approaches. Given the variety of transverse family patterns and characteristics of subtypes, different surgical approaches may be used. Although some risk factors for poor surgical outcomes have been identified 1 , further study is warranted, and additional factors remain to be established. No statistically significant association was observed between surgical approach and the location of the transverse component (p = 0.399), suggesting that a more nuanced approach to fracture morphology may influence the choice of approach. Our findings share some similarities to a retrospective study by Kim et al. who assessed various surgical approaches and outcomes for T-shape acetabular fractures. 2 In this retrospective study, they evaluated the reduction quality using Matta’s criteria after different surgical interventions, including anterior intrapelvic approach (AIP), posterior approach (KL), and percutaneous screw fixation. 2 They concluded that the surgical approach to T-shape acetabular fractures does not impact reduction quality on postoperative CT or the postoperative complication rates. 2 Poor reductions on CT (> 3 mm) were also not associated with fracture classification, unstable pelvic ring injuries, posterior wall fractures, T-stem component, transverse component, preoperative articular displacement, preoperative femoral head protrusion, or surgeon experience. 2 Their finding that 50% of all patients in the study experienced complications 2 underscores the complexity of this fracture type and the challenges in achieving satisfactory outcomes regardless of surgical approach. 2 In Jang et al.’s study investigating prognostic factors associated with poor surgical outcomes for transverse acetabular fractures, multivariate analysis identified dome impaction and wide residual gaps as significant risk factors. 1 In patients with residual gap and step > 3 mm and 1 mm respectively, the development of osteoarthritis increased significantly 1 . Additional risk factors identified for poor outcomes include age over 50 years, BMI classification of overweight, high-energy trauma, articular surface communication or impaction, large initial displacement, femoral head dislocation, residual gap, residual step, and surgeon training. 1 When using axial, coronal, and sagittal CT views to evaluate reduction quality according to Matta’s criteria and implant positions 48–72 hours after surgery 1 , the authors identified a relatively low rate of satisfactory reduction. 1 A major limitation of this study was the small sample size, so the authors concluded that a larger study with additional variables should be carried out to confirm their results. 1 Our results demonstrated that patients who identified as cigarette smokers were more likely to encounter a complication versus those who did not smoke. In addition, these same patients were more likely to have a Matta’s grade of poor. Otherwise, medical comorbidities were not associated with worse outcomes or increased complications. Similar studies such as Hu et al. (2017) investigated the surgical treatment of transverse acetabular fractures with or without posterior wall involvement. In this study, 7 pure transverse and 14 with posterior wall fractures of the acetabulum were surgically treated with anterior column fractures first reduced and temporarily fixed via a modified Smith-Peterson incision before final fixation following posterior column and wall reduction via a Kocher-Langenbeck approach. 3 They found that this approach successfully resulted in anatomic reduction of the anterior column in 20/21 cases and the posterior column in all cases. 3 After following up 18 cases over an average of 16.3 months, they found osseous union in all fractures. 3 Complications included avascular necrosis of the femoral head in 1 case, heterotopic ossification in 3 cases, and anterolateral thigh numbness in 6 cases. 3 Based on these results, the authors recommended sequential reduction and fixation of anterior and posterior columns. They suggested modified Smith-Peterson incision for management of the anterior column is advantageous for direct visualization and to minimize invasiveness 3 . This study has several strengths, including the granular detail obtained for each patient, such as fracture classification, surgical approach, complications, reduction quality, and patient demographics. Most patients underwent CT imaging, allowing for thorough fracture assessment and postoperative evaluation. The study also incorporated a structured model assessment to analyze key variables. However, there were several limitations. The total sample size, as well as the sample size for each surgical approach, was limited. The retrospective nature of the study introduced potential biases and data collection constraints. While no significant differences were observed in surgical approach or reduction quality, patient selection may have influenced the primary outcome. Lastly, patient loss to follow-up restricted the amount of postoperative data available for analysis. Conclusion While challenging, anatomic and good reductions can be achieved in transverse-family acetabular fractures. This retrospective chart review found no significant difference in the quality of reduction or complication rates across different surgical approaches. Approaches for transverse-family acetabular fractures are predicated on careful fracture pattern assessment and technical execution. No difference in approach or outcomes was observed based on location of the transverse fracture component—transtectal, juxtatectal, or infratectal. This finding suggests that other more nuanced fracture morphology characteristics may influence approach selection. Further studies may seek to elucidate how specific fracture characteristics guide operative decision-making in these complex injuries. Declarations Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. Author Contribution A.R. and A.M.S. conceived and designed the study. A.R., A.S., E.M.S., and C.G. collected and interpreted the data. A.S., S.T., and S.S. performed the statistical analysis. A.R., E.M.S., C.G., S.T., and A.M.S. drafted the manuscript. A.R., E.M.S., S.T., and A.M.S. critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript. References Alton TB, Gee AO. Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res. 2014;472(1):35–8. 10.1007/s11999-013-3375-y . Epub 2013 Nov 9. PMID: 24214824; PMCID: PMC3889427. Cimerman M, Kristan A, Jug M, Tomaževič M. Fractures of the acetabulum: from yesterday to tomorrow. International Orthopaedics (SICOT) [Internet]. 2021 [cited 2024 May 19];45(4):1057–64. 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Tables Table #1: Patient Demographics, fracture classification, and return to OR Patient total, n 47 * Demographics Sex Male, n (%) 32, 68% Female, n (%) 15, 32% Average Age, years 40.9 T2DM, n (%) 4, 8.5% BMI > 30, n (%) 22, 47% BMI average 31 Cigarette use, n (%) Alcohol use, n (%) 6, 13% 2, 4.3% Polytrauma, n (%) 34, 72% Fracture classification (Letournal), n 48 Transverse, n (%) 12, 25% Transverse + posterior wall, n (%) 26, 54% T-shaped, n (%) 10, 21% Surgical Approach, n 48 Anterior, n (%) 13, 27% Posterior, n (%) 27, 56% Combined, n (%) 2, 4.2% Percutaneous, n (%) 6, 13% BMI = Body mass index; OR = Operating room; T2DM = Type 2 diabetes mellitus * One individual had two fractures, ultimately resulting in 48 fractures among 47 unique total patients Table #2: Outcomes Based on Demographics Complications Matta’s Grading for Postoperative CT* Matta’s Grading for Postoperative X-ray Yes No P-value Excellent Good/Poor P-value Excellent Good Poor P-value Total 11 37 0.13 37 11 0.13 18 27 3 0.52 Sex (male) 8 25 0.75 25 8 0.75 14 17 2 0.57 T2DM 1 3 1.0 3 1 1.0 1 3 0 0.72 Cigarette use 5 3 0.003 3 5 0.003 5 3 0 0.28 Alcohol Use 1 1 0.41 1 1 0.41 0 2 0 0.57 Polytrauma 10 26 0.25 26 10 0.41 16 18 2 0.18 BMI 0.33 0.33 0.23 ASA 0.16 0.16 0.50 *Data analysis combined patients with “Good” or “Poor” Matta’s scores for postoperative CT * T2DM = Type 2 diabetes mellitus, BMI = body mass index, ASA = American society of anesthesiologist Table #3: Quality of Reduction Measurement Preoperative Mean (mm) Preoperative SD (mm) Postoperative Mean (mm) Postoperative SD (mm) P-value CT - Axial 5.90 6.26 1.58 1.47 < 0.01 CT - Sagittal 4.60 5.80 1.72 1.94 CT - Coronal 5.17 6.27 1.36 0.93 CT - Highest Value 6.82 6.64 1.96 1.93 XR Displacement 5.53 3.85 1.35 0.75 < 0.01 CT = Computed tomography scan; SD = Standard deviation; XR = X-ray Table #4: Matta Grading for postoperative CT Excellent Good Poor Total Surgical approach Anterior 3 8 2 13 Posterior 4 18 5 27 Combined 0 1 1 2 Percutaneous 2 4 0 6 Total 9 31 8 48 P-value 0.71 Transverse fracture to acetabular roof relationship Transtectal 5 20 6 31 Juxtatectal 4 8 2 14 Infratectal 0 3 0 3 Total 9 31 8 48 P-value 0.78 Transverse-family fracture classification Transverse 4 6 2 12 Transverse-PW 4 18 4 26 T-shaped 1 7 2 10 Total 9 31 8 48 P-value 0.65 Surgeon experience, years 5 7 23 7 37 P-value 0.88 Hip dislocation Dislocation 2 16 5 23 No dislocation 7 15 3 25 P-value 0.20 Trans-PW = Transverse posterior wall Table #5: Matta Grading for postoperative X-ray Excellent Good Poor Total Surgical approach Anterior 7 5 0 12 Posterior 7 18 1 26 Combined 1 0 1 2 Percutaneous 2 3 1 6 Total 17 26 3 46 P-value 0.06 Transverse fracture to acetabular roof relationship Transtectal 11 18 1 30 Juxtatectal 5 7 1 13 Infratectal 1 1 1 3 Total 17 26 3 46 P-value 0.43 Transverse-family fracture classification Transverse 7 4 0 11 Trans-PW 6 17 2 25 T-shaped 4 5 1 10 Total 17 26 3 46 P-value 0.19 Surgeon experience, years 5 16 18 3 37 P-value 0.44 Hip dislocation Dislocation 6 14 2 22 No dislocation 11 12 1 24 P-value 0.44 Trans-PW = Transverse posterior wall *Pre-/postoperative comparisons could not be performed for two patients as one patient did not receive a postoperative X-ray while another did not receive a preoperative X-ray. These fractures were excluded from this portion, resulting in 46 considered fractures. Table #6 Comparison of Surgical Approaches by Transverse Component Location (Transtectal, Juxtatectal, Infratectal) Transverse Component Location Surgical Approach Transtectal Juxtatectal Infratectal P-value Anterior 7 5 0 0.399 Posterior 20 6 2 Combined 2 0 0 Percutaneous 2 3 1 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Dec, 2025 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 30 Sep, 2025 Reviews received at journal 27 Sep, 2025 Reviewers agreed at journal 22 Sep, 2025 Reviewers invited by journal 21 Sep, 2025 Editor assigned by journal 21 Sep, 2025 Submission checks completed at journal 18 Sep, 2025 First submitted to journal 06 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7553638","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522720917,"identity":"64947afb-94b6-40fc-bd96-d2d12a594782","order_by":0,"name":"Andrea Rincon, BS","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"BS","middleName":"Andrea","lastName":"Rincon","suffix":""},{"id":522720918,"identity":"c63e3a71-b256-4214-acc0-21e0a612deaa","order_by":1,"name":"Erik-Matthew, BS Sario","email":"","orcid":"","institution":"California Northstate University","correspondingAuthor":false,"prefix":"","firstName":"BS","middleName":"Sario","lastName":"Erik-Matthew","suffix":""},{"id":522720919,"identity":"f03af346-ad49-4ee1-8f73-57b952796517","order_by":2,"name":"Aziz Saade, MD","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"Aziz","middleName":"","lastName":"Saade","suffix":"MD"},{"id":522720920,"identity":"eff080b9-4e6a-4703-a5cd-f868509302bd","order_by":3,"name":"Chiara Giordani, MS","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"MS","middleName":"Chiara","lastName":"Giordani","suffix":""},{"id":522720921,"identity":"7b151b54-0d15-4c59-ad7f-64d701f307a8","order_by":4,"name":"Shannon Tse, BMBS","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"BMBS","middleName":"Shannon","lastName":"Tse","suffix":""},{"id":522720922,"identity":"831724a0-205c-4052-94c8-45787b5c5f8b","order_by":5,"name":"Samuel K. Simister, MD MBA","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"MD","middleName":"Samuel K.","lastName":"Simister","suffix":"MD"},{"id":522720923,"identity":"e0cfec6a-04f1-444b-bfd5-da5657bb7bb7","order_by":6,"name":"Sean T. Campbell, MD","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"Sean","middleName":"T.","lastName":"Campbell","suffix":"MD"},{"id":522720924,"identity":"e916f6ca-2f62-487c-a221-b8b1c3de8585","order_by":7,"name":"Ellen Fitzpatrick, MD","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"Ellen","middleName":"","lastName":"Fitzpatrick","suffix":"MD"},{"id":522720925,"identity":"0330355d-1838-4fd8-92d5-9405a0ea46a4","order_by":8,"name":"Gillian Soles, MD","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"Gillian","middleName":"","lastName":"Soles","suffix":"MD"},{"id":522720926,"identity":"ab7a71af-bf1c-4734-8937-0035c85c01f7","order_by":9,"name":"Mark A. Lee, MD","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"prefix":"","firstName":"Mark","middleName":"A.","lastName":"Lee","suffix":"MD"},{"id":522720930,"identity":"33785652-b759-40bd-b9c9-8f89552a5f05","order_by":10,"name":"Augustine M. Saiz, MD","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIie3OIQvCQBTA8ZdMMuszuH2FG4NhGH6WdwxcWfETaNrimui32EeYGFaGVuXKibBkECwLF5xiEtlpM9yfx6X34x2AyfSvEQTP9zEAxXdk+isB2MJr/wsyWJanq1R7nqVhjVKBbR2om6CIPaS+4Kuq9pEn4A11BEQMSCh4juQxvgCe64gjonNDbNeS6MZIwVxLmCAfiYqWxK6kHhDTEVfE/piK0FtVl5nkCbrrSnYTu/3YsVGTUZZG+aZRgWOVmivv4W/rJpPJZPrcHR3/TCec5jo5AAAAAElFTkSuQmCC","orcid":"","institution":"University of California, Davis","correspondingAuthor":true,"prefix":"","firstName":"Augustine","middleName":"M.","lastName":"Saiz","suffix":"MD"}],"badges":[],"createdAt":"2025-09-07 02:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7553638/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7553638/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13018-025-06490-9","type":"published","date":"2025-12-09T15:57:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92680913,"identity":"9176335c-df16-4e83-9ea8-75724353cb9b","added_by":"auto","created_at":"2025-10-03 01:07:32","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2558723,"visible":true,"origin":"","legend":"","description":"","filename":"AcetabulumManuscriptFinal1.3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7553638/v1/27459dc83b0e2fb447f76fca.docx"},{"id":92680908,"identity":"f9641eaa-08f7-49d5-aad0-950c8db6d026","added_by":"auto","created_at":"2025-10-03 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01:15:32","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99738,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7553638/v1/11e6e6c6d728eacf999ec2d8.html"},{"id":92680906,"identity":"93807ad1-05a8-4719-99e1-80bc52f9f764","added_by":"auto","created_at":"2025-10-03 01:07:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":467666,"visible":true,"origin":"","legend":"\u003cp\u003eStep-off measurement in sagittal computed tomography axis\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7553638/v1/ea511035d563ff5798398881.png"},{"id":92680911,"identity":"605928ca-332e-431e-8725-0421500f1105","added_by":"auto","created_at":"2025-10-03 01:07:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1043460,"visible":true,"origin":"","legend":"\u003cp\u003eStep-off measurement in coronal computed tomography axis\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7553638/v1/87f8827708ee4ca336e427f7.png"},{"id":92680905,"identity":"a4a81018-b6ed-4e5e-9ee7-dace5b69c1ae","added_by":"auto","created_at":"2025-10-03 01:07:32","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1002303,"visible":true,"origin":"","legend":"\u003cp\u003eMax displacement of where the gap of the fracture is the largest in coronal computed tomography axis\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7553638/v1/0f1dfb14fb8e89ab515875a3.png"},{"id":98244836,"identity":"00119392-ef45-4f5c-a6bf-5dbec6105317","added_by":"auto","created_at":"2025-12-15 16:15:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3630594,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7553638/v1/abf473d5-e744-478f-bba6-f1342a56e8e6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Surgical Approach on Reduction Quality for Transverse-Family Acetabulum Fractures","fulltext":[{"header":"Highlights","content":"\u003cp\u003eNo difference in reduction quality between surgical approaches for transverse-family acetabulum fractures.\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eTransverse-family acetabular fractures are relatively uncommon, affecting approximately 3 per 100,000 people annually in the United States (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The incidence of these fractures displays a bimodal age distribution, primarily affecting young (\u0026lt;\u0026thinsp;40 years) from high-energy trauma, or elderly adults from low-impact falls in setting of decreased bone density (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe underlying pathophysiology of transverse-family acetabular fractures involves the impact of the femoral head against the curved articular surface of the acetabulum; however, the pattern varies by position of the hip at the time of impact. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Transverse-family acetabular fractures include transverse, transverse-posterior wall, and T-shape (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The transverse component can be further subclassified based on location in relation to the weight bearing dome as transtectal, juxtatectal, or infratectal. These variable fracture patterns contribute to the complexity requiring thoughtful preop planning and surgical execution.\u003c/p\u003e\u003cp\u003eMost of these acetabular fractures require open reduction and internal fixation (ORIF); however, there is no consensus on standard surgical approach based on fracture pattern. The most common surgical approaches include the modified ilioinguinal approach or the Kocher-Langenbeck approach (sometimes combined). While diverse fracture patterns warrant different approaches for repair, lack of an approach algorithm complicates decision-making and may hinder optimal outcomes in the treatment of acetabular fractures.\u003c/p\u003e\u003cp\u003eReduction of the articular surface and containment of the femoral head are critical for hip survivorship (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Postoperative complications include posttraumatic arthritis and osteonecrosis, infection, iatrogenic nerve injury, deep vein thrombosis, and heterotopic ossification (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Different surgical approaches carry different risks profiles in these fractures.\u003c/p\u003e\u003cp\u003eThe purpose of this study is to evaluate the association of surgical approaches for transverse-family acetabular fracture ORIF based fracture patterns and assess the resulting reduction quality. The secondary objective of this study is to identify factors contributing to malreduction and the incidence of postoperative complications.\u003c/p\u003e"},{"header":"Patient and Methods","content":"\u003cp\u003e Following Institutional Review Board approval, a retrospective study was conducted on patients who underwent surgery for transverse, transverse- posterior wall (TPW), and T-shaped acetabulum fractures at a single Level 1 trauma center over the 6-year period of 2017 to 2023. The T-shaped fractures were further classified based on the T-stem component in relation distally from the obturator foramen as anterior, posterior, or ischial. The transverse component for all subtypes was further classified into intratectal, juxtatectal, and transtectal. Inclusion criteria consisted of patients who underwent surgery for transverse-family acetabulum fractures who were 18 years of age or older and younger than 90 years of age at the time of surgery. The exclusion criteria included non-transverse-family acetabulum fractures, pregnant women, prisoners, and those with no preoperative and postoperative computed tomography (CT) and/or X-ray imaging. All surgeries were performed by fellowship-trained orthopaedic trauma surgeons at our institution.\u003c/p\u003e\u003cp\u003eElectronic medical records were reviewed to obtain patient demographics, injury characteristics, surgery characteristics, postoperative follow-up complications, surgeon experience, mechanism of injury, pelvic injury and whether a hip dislocation was identified preoperatively.\u003c/p\u003e\u003cp\u003eOperative notes were reviewed to categorize what surgical approaches were used including anterior ilioinguinal and/or anterior intrapelvic approach (ANT), the Kocher-Langenbeck (KL) posterior approach, a combination of the two (ANT\u0026thinsp;+\u0026thinsp;KL), or percutaneous screw fixation. Fracture types were classified using Judet and Letournal by operating surgeon.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eReduction Quality\u003c/h2\u003e\u003cp\u003eAll radiographic measurements were performed by a fellowship-trained orthopaedic trauma surgeon on CTs and radiographs. Initial displacement and postoperative reduction quality was determined by measuring maximal displacement and maximal step-off in axial, sagittal, and coronal on preoperative and postoperative CTs. Step-off measurements were completed by creating a circle to fit the acetabular dome and the center of that dome to the first point of step-off was measured using a ruler and a second line ruler started at that same center point to the second point of step-off, the difference between the two measurements was used as our main step-off measurement, a technique explained described by Verbeek et al.(Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eX-ray max displacement was measured preoperatively and postoperatively using the posterior wall or the dome of the acetabulum. For both CT and X-ray, max displacement was measured using the largest space across the acetabular dome. Using Matta\u0026rsquo;s criteria, each measurement was classified as \u0026ldquo;excellent\u0026rdquo; (\u0026lt;\u0026thinsp;1 mm), \u0026ldquo;good\u0026rdquo; (1\u0026ndash;3 mm), or \u0026ldquo;poor\u0026rdquo; (\u0026gt;\u0026thinsp;3 mm).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical t-tests were used to compare the means of the two groups of preoperative and postoperative computed tomography reduction and preoperative and postoperative radiographs and presented as mean differences with 95% confidence interval (CI). Chi-squared and Fischer\u0026rsquo;s exact tests were used to compare categorical variables. A p-value less than 0.05 was statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn our review, 47 patients met inclusion criteria consisting of most commonly male (31/47) patients, with a mean age of 40.9\u0026thinsp;\u0026plusmn;\u0026thinsp;19.1, and an average follow-up of 7.6 months. There were 12 transverse fractures with the following surgical approaches performed: 7 anterior, 3 posterior, and 2 percutaneous. There were 26 TPW fractures with the following surgical approaches performed: 23 posterior, 1 combined, and 2 percutaneous. There were 10 T-shape fractures with the following surgical approaches performed: 5 anterior, 2 posterior, 1 combined, and 2 percutaneous. The transverse fracture components were 31 transtectal, 14 juxtatectal and 3 infratectal (Table\u0026nbsp;1).\u003c/p\u003e\n\u003cp\u003eReduction was noted to varying degrees with an overall preoperative mean maximal displacement (6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64 cm) decreasing on postoperative CT (1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93 cm) for each fracture (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). On CT scans, 37/48 had excellent reductions, 10/48 had good reductions and 1/48 had poor reduction (Table\u0026nbsp;2) (Table\u0026nbsp;3).\u003c/p\u003e\n\u003cp\u003eThere was no significant difference in CT or X-ray quality reduction between surgical approaches(p\u0026thinsp;=\u0026thinsp;0.71; p\u0026thinsp;=\u0026thinsp;0.06), transverse fracture component location (transtectal, juxtatectal, and infratectal) (p\u0026thinsp;=\u0026thinsp;0.78; p\u0026thinsp;=\u0026thinsp;0.43), fracture type (p\u0026thinsp;=\u0026thinsp;0.65; p\u0026thinsp;=\u0026thinsp;0.19), hip dislocation on presentation (p\u0026thinsp;=\u0026thinsp;0.20; p\u0026thinsp;=\u0026thinsp;0.44), and surgeon experience (p\u0026thinsp;=\u0026thinsp;0.88; p\u0026thinsp;=\u0026thinsp;0.10), respectively (Table\u0026nbsp;4, Table\u0026nbsp;5). A statistically significant association was identified between surgical approach and the type of transverse fracture component; transtectal, juxtatectal, or infratectal (p\u0026thinsp;=\u0026thinsp;0.039; Table\u0026nbsp;6). One patient had bilateral fractures, computing a total of 48 fractures included in the analysis. No significant differences were determined for Matta\u0026rsquo;s grades for postoperative CT based on age, sex, diabetic status, alcohol use, BMI, polytrauma status, or ASA. However, zero of the 11 patients who reported a history of smoking had an \u0026ldquo;excellent\u0026rdquo; Matta\u0026rsquo;s grade (p\u0026thinsp;=\u0026thinsp;0.003) on CT. Matta\u0026rsquo;s grades for postoperative X-ray were not significantly different across age, sex, diabetic status, smoking history, alcohol use, BMI, polytrauma status, or ASA.\u003c/p\u003e\n\u003cp\u003eComplications occurred in 12 of the 48 procedures: 3 DVTs, 1 sciatic nerve palsy with Kocher-Langenbeck approach, and 1 patient with sepsis. Of the 48 fractures, 7 (transverse (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e), TPW (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e), T-shape (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)) returned to the OR (3 anterior approach, 3 posterior approach, 1 combined approach, and 0 percutaneous approach) for revision surgeries (3 total hip arthroplasty, 3 debridement for deep infection, and 1 implant removal). The quality reduction in the three patients who underwent subsequent THA was assessed by postoperative imaging. Postoperative computed tomography (CT) demonstrated good reduction in two cases and poor reduction in one case. Postoperative radiographs showed excellent reduction in one case and good reduction in two cases. The intervals from initial open reduction and internal fixation (ORIF) to THA were 3 days, 11 months, and undetermined for the third patient. For the latter case, the patient's medical record contained a gap from 2018 to 2023; however, a CT scan obtained in September 2023 confirmed that a THA had been performed during this interval.\u003c/p\u003e\n\u003cp\u003eComplication rates were not significantly different between surgical approaches (p\u0026thinsp;=\u0026thinsp;0.20) (Table\u0026nbsp;2). Furthermore, no significant difference in complication rates was observed based on age, sex, diabetic status, alcohol use, BMI, polytrauma status, or ASA. Patients who reported cigarette smoking, however, were more likely to experience complications following the procedure, with 5 of the 11 patients who experienced complications reporting a history of smoking (p\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\n\n"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the largest study to assess reduction quality in transverse-family acetabulum fractures when compared to surgical approaches. Given the variety of transverse family patterns and characteristics of subtypes, different surgical approaches may be used. Although some risk factors for poor surgical outcomes have been identified\u003csup\u003e1\u003c/sup\u003e, further study is warranted, and additional factors remain to be established. No statistically significant association was observed between surgical approach and the location of the transverse component (p\u0026thinsp;=\u0026thinsp;0.399), suggesting that a more nuanced approach to fracture morphology may influence the choice of approach.\u003c/p\u003e\u003cp\u003eOur findings share some similarities to a retrospective study by Kim et al. who assessed various surgical approaches and outcomes for T-shape acetabular fractures.\u003csup\u003e2\u003c/sup\u003e In this retrospective study, they evaluated the reduction quality using Matta\u0026rsquo;s criteria after different surgical interventions, including anterior intrapelvic approach (AIP), posterior approach (KL), and percutaneous screw fixation.\u003csup\u003e2\u003c/sup\u003e They concluded that the surgical approach to T-shape acetabular fractures does not impact reduction quality on postoperative CT or the postoperative complication rates.\u003csup\u003e2\u003c/sup\u003e Poor reductions on CT (\u0026gt;\u0026thinsp;3 mm) were also not associated with fracture classification, unstable pelvic ring injuries, posterior wall fractures, T-stem component, transverse component, preoperative articular displacement, preoperative femoral head protrusion, or surgeon experience.\u003csup\u003e2\u003c/sup\u003e Their finding that 50% of all patients in the study experienced complications\u003csup\u003e2\u003c/sup\u003eunderscores the complexity of this fracture type and the challenges in achieving satisfactory outcomes regardless of surgical approach.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn Jang et al.\u0026rsquo;s study investigating prognostic factors associated with poor surgical outcomes for transverse acetabular fractures, multivariate analysis identified dome impaction and wide residual gaps as significant risk factors.\u003csup\u003e1\u003c/sup\u003e In patients with residual gap and step\u0026thinsp;\u0026gt;\u0026thinsp;3 mm and 1 mm respectively, the development of osteoarthritis increased significantly\u003csup\u003e1\u003c/sup\u003e. Additional risk factors identified for poor outcomes include age over 50 years, BMI classification of overweight, high-energy trauma, articular surface communication or impaction, large initial displacement, femoral head dislocation, residual gap, residual step, and surgeon training.\u003csup\u003e1\u003c/sup\u003e When using axial, coronal, and sagittal CT views to evaluate reduction quality according to Matta\u0026rsquo;s criteria and implant positions 48\u0026ndash;72 hours after surgery\u003csup\u003e1\u003c/sup\u003e, the authors identified a relatively low rate of satisfactory reduction.\u003csup\u003e1\u003c/sup\u003e A major limitation of this study was the small sample size, so the authors concluded that a larger study with additional variables should be carried out to confirm their results.\u003csup\u003e1\u003c/sup\u003e Our results demonstrated that patients who identified as cigarette smokers were more likely to encounter a complication versus those who did not smoke. In addition, these same patients were more likely to have a Matta\u0026rsquo;s grade of poor. Otherwise, medical comorbidities were not associated with worse outcomes or increased complications.\u003c/p\u003e\u003cp\u003eSimilar studies such as Hu et al. (2017) investigated the surgical treatment of transverse acetabular fractures with or without posterior wall involvement. In this study, 7 pure transverse and 14 with posterior wall fractures of the acetabulum were surgically treated with anterior column fractures first reduced and temporarily fixed \u003cem\u003evia\u003c/em\u003e a modified Smith-Peterson incision before final fixation following posterior column and wall reduction \u003cem\u003evia\u003c/em\u003e a Kocher-Langenbeck approach.\u003csup\u003e3\u003c/sup\u003e They found that this approach successfully resulted in anatomic reduction of the anterior column in 20/21 cases and the posterior column in all cases.\u003csup\u003e3\u003c/sup\u003e After following up 18 cases over an average of 16.3 months, they found osseous union in all fractures.\u003csup\u003e3\u003c/sup\u003e Complications included avascular necrosis of the femoral head in 1 case, heterotopic ossification in 3 cases, and anterolateral thigh numbness in 6 cases.\u003csup\u003e3\u003c/sup\u003e Based on these results, the authors recommended sequential reduction and fixation of anterior and posterior columns. They suggested modified Smith-Peterson incision for management of the anterior column is advantageous for direct visualization and to minimize invasiveness\u003csup\u003e3\u003c/sup\u003e. This study has several strengths, including the granular detail obtained for each patient, such as fracture classification, surgical approach, complications, reduction quality, and patient demographics. Most patients underwent CT imaging, allowing for thorough fracture assessment and postoperative evaluation. The study also incorporated a structured model assessment to analyze key variables. However, there were several limitations. The total sample size, as well as the sample size for each surgical approach, was limited. The retrospective nature of the study introduced potential biases and data collection constraints. While no significant differences were observed in surgical approach or reduction quality, patient selection may have influenced the primary outcome. Lastly, patient loss to follow-up restricted the amount of postoperative data available for analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhile challenging, anatomic and good reductions can be achieved in transverse-family acetabular fractures. This retrospective chart review found no significant difference in the quality of reduction or complication rates across different surgical approaches. Approaches for transverse-family acetabular fractures are predicated on careful fracture pattern assessment and technical execution. No difference in approach or outcomes was observed based on location of the transverse fracture component\u0026mdash;transtectal, juxtatectal, or infratectal. This finding suggests that other more nuanced fracture morphology characteristics may influence approach selection. Further studies may seek to elucidate how specific fracture characteristics guide operative decision-making in these complex injuries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.R. and A.M.S. conceived and designed the study. A.R., A.S., E.M.S., and C.G. collected and interpreted the data. A.S., S.T., and S.S. performed the statistical analysis. A.R., E.M.S., C.G., S.T., and A.M.S. drafted the manuscript. A.R., E.M.S., S.T., and A.M.S. critically revised the manuscript for important intellectual content.\u0026nbsp; All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlton TB, Gee AO. 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Patient Saf Surg. 2019;13:16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13037-019-0196-2\u003c/span\u003e\u003cspan address=\"10.1186/s13037-019-0196-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable #1: Patient Demographics, fracture classification, and return to OR\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePatient total, n\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e47\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMale, n (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32, 68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFemale, n (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15, 32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage Age, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2DM, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4, 8.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;30, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22, 47%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI average\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCigarette use, n (%)\u003c/p\u003e\n \u003cp\u003eAlcohol use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6, 13%\u003c/p\u003e\n \u003cp\u003e2, 4.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolytrauma, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34, 72%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFracture classification (Letournal), n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransverse, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12, 25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransverse\u0026thinsp;+\u0026thinsp;posterior wall, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26, 54%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT-shaped, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10, 21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical Approach, n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnterior, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13, 27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePosterior, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27, 56%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2, 4.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePercutaneous, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6, 13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eBMI\u0026thinsp;=\u0026thinsp;Body mass index; OR\u0026thinsp;=\u0026thinsp;Operating room; T2DM\u0026thinsp;=\u0026thinsp;Type 2 diabetes mellitus\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u003cem\u003e*\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eOne individual had two fractures, ultimately resulting in 48 fractures among 47 unique total patients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable #2: Outcomes Based on Demographics\u003c/p\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eMatta\u0026rsquo;s Grading for Postoperative CT*\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eMatta\u0026rsquo;s Grading for Postoperative X-ray\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eExcellent\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGood/Poor\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eExcellent\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGood\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePoor\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCigarette use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlcohol Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolytrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e*Data analysis combined patients with \u0026ldquo;Good\u0026rdquo; or \u0026ldquo;Poor\u0026rdquo; Matta\u0026rsquo;s scores for postoperative CT\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cp\u003e* T2DM\u0026thinsp;=\u0026thinsp;Type 2 diabetes mellitus, BMI\u0026thinsp;=\u0026thinsp;body mass index, ASA\u0026thinsp;=\u0026thinsp;American society of anesthesiologist\u003c/p\u003e\n \u003cp\u003eTable #3: Quality of Reduction\u0026nbsp;\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMeasurement\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePreoperative Mean (mm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePreoperative SD (mm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePostoperative Mean (mm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePostoperative SD (mm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT - Axial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT - Sagittal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT - Coronal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT - Highest Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eXR Displacement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eCT\u0026thinsp;=\u0026thinsp;Computed tomography scan; SD\u0026thinsp;=\u0026thinsp;Standard deviation; XR\u0026thinsp;=\u0026thinsp;X-ray\u003c/p\u003e\n\u003cp\u003eTable #4: Matta Grading for postoperative CT\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabd\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eSurgical approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePosterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eTransverse fracture to acetabular roof relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTranstectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJuxtatectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInfratectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eTransverse-family fracture classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransverse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransverse-PW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT-shaped\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eSurgeon experience, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eHip dislocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDislocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo dislocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTrans-PW\u0026thinsp;=\u0026thinsp;Transverse posterior wall\u003c/p\u003e\n\u003cp\u003eTable #5: Matta Grading for postoperative X-ray\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabe\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eSurgical approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePosterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eTransverse fracture to acetabular roof relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTranstectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJuxtatectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInfratectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eTransverse-family fracture classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransverse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrans-PW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT-shaped\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eSurgeon experience, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eHip dislocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDislocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo dislocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003cp\u003eTrans-PW\u0026thinsp;=\u0026thinsp;Transverse posterior wall\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e*Pre-/postoperative comparisons could not be performed for two patients as one patient did not receive a postoperative X-ray while another did not receive a preoperative X-ray. These fractures were excluded from this portion, resulting in 46 considered fractures.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eTable #6 Comparison of Surgical Approaches by Transverse Component Location (Transtectal, Juxtatectal, Infratectal)\u0026nbsp;\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tabf\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eTransverse Component Location\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eSurgical Approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTranstectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJuxtatectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInfratectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePosterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"acetabulum, fracture, transverse, reduction quality, anterior approach, posterior approach","lastPublishedDoi":"10.21203/rs.3.rs-7553638/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7553638/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cdiv id=\"ASec1\" class=\"AbstractSection\"\u003e\u003cdiv class=\"Heading\"\u003eIntroduction:\u003c/div\u003e\u003cp\u003eGiven the variety of transverse acetabular fracture patterns, different approaches are used for surgical fixation. The purpose of this study is to determine the association between surgical approach and fracture pattern on reduction quality in patients with transverse-family acetabular fractures.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"ASec2\" class=\"AbstractSection\"\u003e\u003cdiv class=\"Heading\"\u003eMethods\u003c/div\u003e\u003cp\u003eA retrospective review was performed on adult patients with transverse-family acetabular fractures undergoing surgical fixation at a level 1 trauma institution between 2017\u0026ndash;2023. The primary outcome was reduction quality based on Matta\u0026rsquo;s criteria using postoperative computed tomography (CT) scans and X-rays. On CT scans, the greatest gap displacement and step-off was recorded in all three planes. On X-rays, gap displacement was measured on AP. Secondary outcomes included surgical complications.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"ASec3\" class=\"AbstractSection\"\u003e\u003cdiv class=\"Heading\"\u003eResults\u003c/div\u003e\u003cp\u003eOn review, 47 patients were included, 68.1% were male with a mean age of 40.1, and an average follow-up of 8 months. Fractures included 12 transverse (approaches: 58.3% anterior, 25% posterior, and 16.7% percutaneous), 26 TP wall (88.4% posterior, 3.8% combined anterior-posterior (AP), and 7.8% percutaneous), and 10 T-shape (approaches: 50% anterior, 20% posterior, 10% combined AP, and 20% percutaneous). Reduction was assessed on postoperative CT with a significant difference in preoperative (6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64 cm) and postoperative (1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93 cm) mean maximal displacement (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). On CT scans, 19% had anatomic reductions, 65% had good reductions, and 16% had poor reductions. There was no significant difference in CT or X-ray quality reduction between surgical approaches, transverse-family fracture type, hip dislocation on presentation, and surgeon experience, respectively. Patients who were cigarette smokers were more likely to have complications and Matta\u0026rsquo;s grade of \u0026lsquo;(p\u0026thinsp;=\u0026thinsp;0.003, =\u0026thinsp;0.003, respectively).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"ASec4\" class=\"AbstractSection\"\u003e\u003cdiv class=\"Heading\"\u003eConclusion\u003c/div\u003e\u003cp\u003eAlthough challenging, anatomic and good reductions can be achieved in transverse-family acetabular fractures. There were no observed differences in the quality of reduction or complication rates between different surgical approaches. Approaches for transverse-family acetabular fractures are predicated on careful fracture pattern assessment to determine surgical approach followed by technical execution.\u003c/p\u003e\u003c/div\u003e","manuscriptTitle":"Evaluation of Surgical Approach on Reduction Quality for Transverse-Family Acetabulum Fractures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 01:07:27","doi":"10.21203/rs.3.rs-7553638/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-30T08:14:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-27T13:15:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16419334887240513660404503552580668327","date":"2025-09-22T12:17:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-21T08:39:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-21T08:16:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-18T04:53:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2025-09-07T02:50:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d1f14ab-9177-458b-9fa5-015d8f64296f","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:09:44+00:00","versionOfRecord":{"articleIdentity":"rs-7553638","link":"https://doi.org/10.1186/s13018-025-06490-9","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2025-12-09 15:57:07","publishedOnDateReadable":"December 9th, 2025"},"versionCreatedAt":"2025-10-03 01:07:27","video":"","vorDoi":"10.1186/s13018-025-06490-9","vorDoiUrl":"https://doi.org/10.1186/s13018-025-06490-9","workflowStages":[]},"version":"v1","identity":"rs-7553638","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7553638","identity":"rs-7553638","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}