Treatment of Geriatric Acetabular Anterior Fractures: Role of “Frame and Buttress”

Background: As the rate of geriatric acetabular fractures was increasing gradually and accompanied with the quadrilateral surface(QLS) involved resulting by impacting from the head of femur, which usually leaded to the dislocation/subluxation of the head of femur and intra-pelvic medial displacement of the QLS. Traditionally, applying an infra-pectineal buttress plate in the true pelvis to resist the protrusive fragments of the QLS, however, these plates with small contact area could not provide enough buttress effect to age-related fractures. This study was to evaluate the “frame and buttress” fixation strategy for treatment of geriatric acetabular anterior fractures(GAAF). Methods: : A cohort of 28 patients with acetabular fractures involving QLS were managed operatively with the “frame and buttress” fixation strategy with a single pelvic anterior approach. 7 cases were transverse, 3 cases were posterior column, 8 cases were associated both columns, 4 cases were anterior posterior hemi-transverse and 6 cases were T-type patterns fracture. The quality of reduction, functional outcomes and complicates were recorded for analyzing. Results: : Functional outcomes were 15 cases in excellent; 9 cases were good; 3 cases were fair, and 1 case was poor. The quality of surgical reduction was evaluated by the Matta score system, which was graded as excellent in 17 cases, good in 9 cases and poor in 2 cases, respectively. No loss or failure of internal fixation, no second dislocation/subluxation of femoral head and no complications like infection were observed. Conclusions: : The “frame and buttress” fixation strategy provided firm method for treating GAAF, the “frame” formed rigid fixation structure for acetabular fractures and the “buttress” resisted protrusive QLS.