Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: An anatomical–morphological study

Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: An anatomical–morphological study | 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 Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: An anatomical–morphological study chongshuai bao, xuhang yan, li he, qingshuang yao, lin chen, jun ao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3993761/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Objective: To digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to develop anatomical plates that align with the characteristics of the pelvis in the Chinese population. Methods: Pelvic computed tomography (CT) data from 102 adult patients were collected at the Affiliated Hospital of Zunyi Medical University. This group included 51 males and 51 females, aged between 20–60 years. Using Mimics software (version 21.0), a three-dimensional model of each pelvic data point was reconstructed. The fixation path for the combined reset anatomical steel plate was drawn, where the curves on the fixation path were approximated as arcs. The radius of curvature and length of these curves were measured, and an anatomical steel plate was designed to best fit the pelvic structure. Results: The combined anatomical reduction plate fixation system for quadrilateral acetabular fractures using a posterior approach consisted of two parts: a locking plate and a reduction plate. The posterior wall region (r2), ischial region (r3), quadrilateral region (r4), and bending region (r5), and the total length of the reduction plate were significantly smaller in females (P<0.05). Similarly, the posterior wall region (R3), distal posterior wall region (R4), and the total length of the locking plate were significantly smaller in females (P<0.05). Additionally, the anterior superior iliac spine side (r1) and the total length of the T-shaped auxiliary plate were significantly smaller in females (P<0.05). The bending angle (<A) was also significantly smaller in females (P<0.05). Conclusions: The combined reduction anatomical plate designed in this study demonstrated high precision and improved conformity to the anatomical structure of the pelvis. This design reduces the difficulty of plate shaping during surgery, decreases operative time, and facilitates clinical application. acetabular fracture quadrilateral region reduction and internal fixation digital measurement Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Acetabular fractures are complex intra-articular fractures often accompanied by multiorgan dysfunction. Due to their deep anatomical location and intricate structure, the treatment of acetabular fractures remains a significant challenge for orthopedic surgeons. Key factors such as anatomical reduction of the fracture, rigid internal fixation, and early functional exercise are crucial for optimal outcomes. [1-3] . In recent years, an increase in traffic and construction accidents has led to a rise in acetabular fractures. [4] The standard treatment for unstable acetabular fractures involves open reduction and internal fixation. [5,6] Before the 1960s, conservative treatments like traction reduction and external orthosis were commonly employed for quadrilateral acetabular fractures. [7,8] However, with continuous medical advancements and a deeper understanding of anatomical structures, surgery have become the preferred method for treating these fractures. Traditional internal fixation options for displaced quadrilateral fractures include wire-plate composite systems, [9] T-plates, [10] I-plates, [11] iliosacral plates, [12] and posterior column plates. [13] Although these surgical techniques and internal fixation devices have made some advances in the treatment of involved quadrilateral fractures, they still have some shortcomings, such as the requirement of high surgical skill and operator experience, a higher incidence of postoperative traumatic arthritis, the possibility of greater trauma, a prolonged operative time, increased intraoperative bleeding, and an increased probability of postoperative complications. [11,14,15] To overcome the shortcomings of traditional plates, domestic and foreign researchers have conducted numerous studies on pelvic rim screws [16], suprapubic quadrilateral body surface support plates, [17] and a new dynamic anterior plate-screw fixation system; [18] however, considerable controversy remains regarding the optimal surgical treatment of quadrilateral fractures. Therefore, we aimed to innovatively design a novel shape for the reconstruction steel plate, named the combined reduction anatomical plate. This fixation system consists of two parts: a locking plate and a reduction plate. The locking plate is a curved strip plate that fits above the large sciatic notch. The reduction plate consists of the first plate, the second plate, the third plate, and the T-type auxiliary plate. The first plate is bent to fit the anatomical structure above the acetabulum, the second plate intersects with the locking plate, the third plate is bent to fit the anatomical structure of the acetabular quadrilateral body, and the T-type auxiliary plate is molded integrally with the first plate and fixed to the anterior column of the acetabulum (shown in Figure 1). This fixation system has been granted a Chinese Patent (Patent No. CN202210974276.4). However, this fixation system must be shaped based on the characteristics of the acetabulum and the surgeon’s experience. For inexperienced surgeons, poor precision of intraoperative plate shaping may lead to a loss of reset. To achieve a standard for the combined reduction anatomical steel plate with higher precision, a better fit to the pelvic surface anatomical structure, a reduction in operation time, and an improvement in therapeutic effect are required; therefore, this study utilized a three-dimensional (3D) model of the pelvis, measured the anatomical morphology parameters of the bone surface on the fixation path of this fixation system, and summarized the features of the plate to design and develop an anatomical steel plate with higher precision and in line with the pelvic structure of the Chinese population. 2. Materials And Methods We collected data from adult patients who underwent pelvic CT+3D at the affiliated hospital of Zuni Medical University between January 2022 and January 2023. A total of 102 cases of partial pelvic data were obtained, including 51 males with an age range of 22–60 years and an average age of 44.37 years, and 51 females with an age range of 23–60 years and an average age of 47.88 years. The age difference was not statistically significant (P>0.05). In this study, all patients were required to meet the following inclusion criteria: no lesions, fractures, tumors, or anatomical abnormalities on one or both sides of the pelvis and age between 20–60 years. All CT data were acquired using a 64-channel helical CT scanner with a slice thickness of 1 mm, and were saved in DICOM format. The DICOM CT data were imported into Mimics 21.0 (Materialise Company, Leuven, Belgium). Then, through threshold segmentation, region growing, and smoothing to remove soft tissue, a 3D pelvic model was reconstructed and saved in STL format. The STL-format pelvic 3D model was further processed using 3-matic software for wrapping, smoothing, and mesh reduction to obtain a standardized pelvic 3D model (Figure 2). The fixation trajectory of the combined reduction and anatomical plate was drawn. The proximal end of the reduction plate started from the anterior inferior iliac spine, followed the posterior wall of the acetabulum, and extended to the distal end until a third of the way down the line between the greater ischial notch and the ischial spine, which was at the projection point on the fixation trajectory. It then curved to the quadrilateral body. The reduction plate and T-type auxiliary plate were fixed to the anterior column of the acetabulum. The locking plate began 1 cm below the anterior inferior iliac spine, parallel to the reduction plate, and extended distally to the apex of the ischial tuberosity (as shown in Figure 1). The Trim command under the Finish function list in the 3-matic software was used to create the profile that crossed the centerline of the steel plate. The fixation trajectory of the reduction plate can be considered as five arcs with the radii of curvature of the ilium (r1), posterior wall (r2), ischium (r3), quadrilateral area (r4), and bending area (r5). The radius of curvature of the locking plate can be divided into four arcs: the iliac region (R1), proximal posterior wall (R2), posterior wall region (R3), and distal posterior wall (R4). The fixed trajectory of the T-shaped auxiliary plate can be regarded as two arcs with radii of curvature at the posterior superior iliac spine side (r6) and the anterior superior iliac spine side (r7) (as shown in Figure 3). Each arc was fitted using the software, and the diameter and length of the circle were measured directly using the software. The arc length of each arc can be calculated by the formula [18] : arc length = diameter × (arc in chord length/diameter), and the length of the plate was obtained by summing the arc lengths. Simultaneously, the degree of bending of the reduction plate to the square was measured (< A °) using the measuring tool in the software. 3. Data analysis SPSS 29.0 (IBM Corp., Armonk, NY, USA, Version 29.0) was used to process and analyze the data. All data were expressed as mean ± standard deviation (SD). Differences were considered statistically significant at P<0.05. 4. Results 4.1 Comparison of the length of each section and the total length of the reduction plate between males and females In this study, hemipelvic data were obtained from 51 males aged 22–60 years, with an average age of 44.37 years. The average arc lengths of r1, r2, r3, r4, and r5 were 54.09 ± 5.30 mm (42.74–67.26 mm), 34.34 ± 4.57 mm (24.92–45.80 mm), 30.54 ± 2.99 mm (26.38–37.92 mm), 25.39 ± 4.11 mm (14.61–33.68 mm), and 7.77 ± 1.73 mm (4.52–13.82 mm), respectively, with a total length of 151.70 ± 11.55 mm (125.25–178.21 mm). In addition, hemipelvic data were obtained from 51 females aged 23–60 years, with an average age of 47.88 years. The average arc lengths of r1, r2, r3, r4, and r5 were 53.80 ± 3.90 mm (47.01–68.78 mm), 32.48 ± 4.73 mm (23.98–44.93 mm), 26.97 ± 3.20 mm (21.25–34.30 mm), 22.39 ± 3.87 mm (13.15–31.17 mm), and 6.35 ± 1.70 mm (3.22–11.84 mm), respectively, with a total length of 141.99 ± 8.94 mm (117.56–158.19 mm). The statistical results indicate that there was no significant difference in the arc length of r1 between males and females (P>0.05); however, the arc lengths of r2, r3, r4, and r5, and the total length of the reduction plate in females were significantly shorter than those in males (P<0.05; Table 1). Table 1. Comparison of the length of each zone and the total length of the reduction plate trajectory between males and females (mm, mean ± standard deviation) Gender n Iliac (r1) Posterior wall (r2) Ischial (r3) Quadrilateral (r4) Bending zone (r5) Total length Male 51 54.095.30 34.34±4.57 30.54±2.99 25.39±4.11 7.77±1.73 151.70±11.55 Female 51 53.80 ±3.90 32.48±4.73 26.97±3.20 22.39±3.87 6.35±1.70 141.99±8.94 t 0.308 2.026 5.834 3.798 4.178 4.747 P 0.759 0.045 <0.001 <0.001 <0.001 <0.001 4.2 Comparison of length of each zone and total length of the locking plate between males and females The average arc lengths of R1, R2, R3, and R4, and the total arc length in the 51 males were 36.61 ± 5.12 mm (24.86–47.66 mm), 14.06 ± 2.98 mm (7.80–21.37 mm), 32.62 ± 4.61 mm (19.50–43.78 mm), 32.18 ± 4.95 mm (21.33–45.19 mm), and 115.46 ± 8.82 mm (96.63–134.84 mm), respectively. The average arc lengths of R1, R2, R3, and R4, and the total arc length in the 51 females were 36.55 ± 5.18 mm (25.58–53.87 mm), 14.93 ± 3.43 mm (4.59–20.17 mm), 30.29 ± 4.46 mm (21.00–43.09 mm), 26.84 ± 4.44 mm (17.39–38.43 mm), and 108.61 ± 7.26 mm (93.70–123.13 mm), respectively.The statistical results indicate that there was no significant difference in the arc lengths of R1 and R2 between males and females (P>0.05); however, the arc lengths and the total length of the locking plate for R3 and R4 in females were significantly shorter than those in males (P<0.05; Table 2). Table 2. Comparison of the length of each zone and the total length of the locking plate trajectory between males and females (mm, mean ± standard deviation) Gender n Iliac (R1) Proximal to posterior wall (R2) Posterior wall (R3) Distal to the posterior wall (R4) Total length Male 51 36.61±5.12 14.06±2.98 32.62±4.61 32.18±4.95 115.46±8.82 Female 51 36.55±5.18 14.93±3.43 30.29±4.46 26.84±4.44 108.61±7.26 t 0.053 1.366 2.592 5.729 4.286 P 0.958 0.175 0.011 <0.001 <0.001 4.3 Comparison of the sectional length, total length, and bending angle (< A °) between males and females The average values of the arc length, corresponding to r6 and r7, total length, and bending angle (< A °) in the 51 male pelvic T-shaped auxiliary steel plates were 28.16 ± 5.17 mm (18.42–42.31 mm), 46.50 ± 5.37 mm (33.97–62.22 mm),74.67 ± 6.81 mm (57.62–85.17 mm), and 83.58 ± 13.99° (56.63–114.79°), respectively. In the 51 female pelvic T-shaped auxiliary steel plates, the average values of the arc length, corresponding to r6 and r7, total length, and bending angle (< A °) were 27.09 ± 5.40 mm (15.28–39.83 mm), 42.61 ± 5.51 mm (23.94–53.96 mm),69.70 ± 6.82 mm (51.40–88.08 mm), and 71.99 ± 14.74° (42.06–104.71°). The statistical analysis indicated no significant difference (P>0.05) in the arc length of r6 between males and females, while the arc length of r7 and the total length of the T-shaped auxiliary plate in females were significantly smaller than those in males (P<0.05). The bending angle (< A °) in females was also significantly smaller than in males (P<0.05; Table 3). Table 3. Comparison of sectional length, total length, and bending angle (mm, °, mean ± standard deviation) Gender n Posterior superior iliac spine side (r6) Anterior superior iliac spine (r7) Total length Bending angle (< A °) Male 51 28.16±5.17 46.50±5.37 74.67±6.81 83.58±13.99 Female 51 27.09±5.40 42.61±5.51 69.70±6.82 71.99±14.74 t 1.023 3.616 3.676 4.073 P 0.309 <0.001 <0.001 <0.001 5. Discussion The combined reduction anatomical plate in this study is an anatomical plate, it can significantly reduce the difficulty of shaping the plate during operation, and creatively realize the single posterior K-L approach can solve the difficulties of traditional combined approaches for the treatment of complex acetabular fractures, which is convenient for operation and improves prognosis. However, this study has some limitations. For example, our measurements were representative of specific populations and may not be generalizable to all races. Typically, pelvic anatomy varies greatly depending on the geographical location and population. Previous studies have shown a decreasing trend in pelvic size from high to low latitudes.[30] In addition, the different physiological functions of men and women determine morphological differences in the pelvis.[31] In the software measurement process, errors caused by human factors are inevitable when the landmarks are determined. Additionally, screws were not considered in this study, and in a follow-up study, we will further optimize them to improve the treatment effect. 6. Conclusions In this study, digital technology was used to measure the fixation trajectory of a combined anatomical reduction plate, which provided an anatomical basis for plate design. Simultaneously, it overcomes the shortcomings of traditional cadaveric bone samples and large measurement errors. Although the anatomical plate we designed could not meet the anatomical structure of all populations, its accuracy was higher than that of traditional reconstruction plates. It can be used to treat quadrilateral acetabular fracture. so that the treatment methods become diversified. In addition, it can reduce the time required to shape the plate, operative time, bleeding, and the surgical risk. Finally, the clinical outcomes of the fixation devices used in this study will be investigated in future studies. Declarations This study was approved by the Institutional Review Board of the Affiliated Hospital of Zunyi Medical University, Zunyi, Guizho, China.All subjects provided informed consent to take part in the study. All procedures were conducted according to the 1964 Declaration of Helsinki and its amendments. Conflicting of interests: All authors declare no conflict of interest. Funding: All authors declare no financial interest. Author contributions: Bao CS: Data measurement, data analysis, main contributors to writing the paper.Yan XH, He L ,Yao QS :Participated in study conception, supervised data measurement, and data analysis . Chen L and Ao J Participated in study design, data analysis, and paper revision. All the authors read and approved the final manuscript. Availability of data and materials ： The datas used and analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This study was approved by the Institutional Review Board of the Affiliated Hospital of Zunyi Medical University, Zunyi, Guizho, China, Ethics number KLLY-2022-017. All subjects provided informed consent to take part in the study. All procedures were conducted according to the 1964 Declaration of Helsinki and its amendments. References Matta JM. 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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-3993761","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276339015,"identity":"0cd9626c-f223-4b59-8827-de7892f0c349","order_by":0,"name":"chongshuai bao","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":false,"prefix":"","firstName":"chongshuai","middleName":"","lastName":"bao","suffix":""},{"id":276339016,"identity":"09562c01-ffde-4860-b77e-541ceb074b32","order_by":1,"name":"xuhang yan","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":false,"prefix":"","firstName":"xuhang","middleName":"","lastName":"yan","suffix":""},{"id":276339017,"identity":"c418c11e-a49a-4a69-8fad-bf4002ea49ae","order_by":2,"name":"li he","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":false,"prefix":"","firstName":"li","middleName":"","lastName":"he","suffix":""},{"id":276339018,"identity":"33b84f30-34f2-440a-919d-05fee9a8e63e","order_by":3,"name":"qingshuang yao","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":false,"prefix":"","firstName":"qingshuang","middleName":"","lastName":"yao","suffix":""},{"id":276339019,"identity":"8d1a1610-e607-49b7-af3a-d40410692d70","order_by":4,"name":"lin chen","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":false,"prefix":"","firstName":"lin","middleName":"","lastName":"chen","suffix":""},{"id":276339020,"identity":"c84534ff-774d-47e1-9b84-c547ab463cdf","order_by":5,"name":"jun ao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYFACxoYDEgwMcmzs7QeI1cJ88AFQizEfz5kEYrWwJRsAycR5Eg4GxGngb+8xk7Bsu5PeJsGQwPCjYhthLRJnzphJSLY9y22TbjzA2HPmNhHW3MgBaTmc2yZzIIGZsY0ILfJQLelsEgkGxGkxuJGWbADUkkC8FsMzh4GBfO6wYRswkA8S5Re5440NhyXKDsvLt7cffPCjghjvAwGzBJRxgDj1QMD4gWilo2AUjIJRMCIBAFFHPZOM//5lAAAAAElFTkSuQmCC","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":true,"prefix":"","firstName":"jun","middleName":"","lastName":"ao","suffix":""}],"badges":[],"createdAt":"2024-02-27 11:46:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3993761/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3993761/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52039582,"identity":"eaa723ba-b5ed-47d4-8f30-ff5464d062c8","added_by":"auto","created_at":"2024-03-05 17:41:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":192576,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eCombined reduction anatomical plates\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figures1.png","url":"https://assets-eu.researchsquare.com/files/rs-3993761/v1/7fde2e88617185429266a3a5.png"},{"id":52039585,"identity":"853fdf00-86eb-4c58-b710-ad088fddc095","added_by":"auto","created_at":"2024-03-05 17:41:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104794,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThree-dimensional model of the pelvis\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figures2.png","url":"https://assets-eu.researchsquare.com/files/rs-3993761/v1/19a4b78665cfd8d2b1829aa9.png"},{"id":52039583,"identity":"28895102-82c2-4868-80cf-a92dc8b09527","added_by":"auto","created_at":"2024-03-05 17:41:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":404955,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe fixed trajectory of the combined anatomical reduction plate was viewed as arcs with different radii of curvature. A to C are the five arcs of the reduction plate (r1, r2, r3, r4, and r5) and the bending angle (\u0026lt; A °). D is the two circular arcs of the T-type auxiliary plate (r6 and r7). E–G are the four circular arcs of the locking plate (R1, R2, R3, and R4). Each circular arc is fitted by the software, and the diameter and length of the circle can be measured directly by the software. The arc length of each circular arc can be calculated by the formula\u003c/strong\u003e\u003c/em\u003e\u003csup\u003e[18]\u003c/sup\u003e\u003cem\u003e\u003cstrong\u003e: arc length = diameter × (arc in chord length/diameter). The length of the steel plate can be obtained by summing the arc lengths. Using the measuring tool in the software, the degree of bending of the reduction plate to the quadsquare was measured (\u0026lt; A °). I and J show the continuous irregular curve of the plate fixation trajectory.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figures3.png","url":"https://assets-eu.researchsquare.com/files/rs-3993761/v1/e1fd0d97e1008d68af6f1e2a.png"},{"id":52040347,"identity":"e1780cd4-7907-41e3-be71-229ff62291f3","added_by":"auto","created_at":"2024-03-05 17:49:31","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":139416,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe combined anatomical reduction plates selected for the digital measurement in this study has high accuracy\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figures4.png","url":"https://assets-eu.researchsquare.com/files/rs-3993761/v1/768af515b1de964bf654e157.png"},{"id":52040607,"identity":"c1faa486-9f87-4428-82d0-254313b8869a","added_by":"auto","created_at":"2024-03-05 17:57:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1511823,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3993761/v1/f7db67cf-1e17-4083-bdec-af300535fcc9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: An anatomical–morphological study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAcetabular fractures are complex intra-articular fractures often accompanied by multiorgan dysfunction. Due to their deep anatomical location and intricate structure, the treatment of acetabular fractures remains a significant challenge for orthopedic surgeons. Key factors such as anatomical reduction of the fracture, rigid internal fixation, and early functional exercise are crucial for optimal outcomes.\u003csup\u003e[1-3]\u003c/sup\u003e . In recent years, an increase in traffic and construction accidents has led to a rise in acetabular fractures.\u003csup\u003e[4]\u003c/sup\u003e The standard treatment for unstable acetabular fractures involves open reduction and internal fixation.\u003csup\u003e[5,6]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eBefore the 1960s, conservative treatments like traction reduction and external orthosis were commonly employed for quadrilateral acetabular fractures.\u003csup\u003e[7,8]\u003c/sup\u003e However, with continuous medical advancements and a deeper understanding of anatomical structures, surgery have become the preferred method for treating these fractures. Traditional internal fixation options for displaced quadrilateral fractures include wire-plate composite systems,\u003csup\u003e[9]\u0026nbsp;\u003c/sup\u003eT-plates,\u003csup\u003e[10]\u0026nbsp;\u003c/sup\u003eI-plates,\u003csup\u003e[11]\u003c/sup\u003e iliosacral plates,\u003csup\u003e[12]\u003c/sup\u003e and posterior column plates.\u003csup\u003e[13]\u003c/sup\u003e Although these surgical techniques and internal fixation devices have made some advances in the treatment of involved quadrilateral fractures, they still have some shortcomings, such as the requirement of high surgical skill and operator experience, a higher incidence of postoperative traumatic arthritis, the possibility of greater trauma, a prolonged operative time, increased intraoperative bleeding, and an increased probability of postoperative complications.\u003csup\u003e[11,14,15]\u0026nbsp;\u003c/sup\u003eTo overcome the shortcomings of traditional plates, domestic and foreign researchers have conducted numerous studies on pelvic rim screws \u003csup\u003e[16],\u003c/sup\u003e suprapubic quadrilateral body surface support plates,\u003csup\u003e[17]\u003c/sup\u003e and a new dynamic anterior plate-screw fixation system;\u003csup\u003e[18]\u003c/sup\u003e however, considerable controversy remains regarding the optimal surgical treatment of quadrilateral fractures.\u003c/p\u003e\n\u003cp\u003eTherefore, we aimed to innovatively design a novel shape for the reconstruction steel plate, named the combined reduction anatomical plate. This fixation system consists of two parts: a locking plate and a reduction plate. The locking plate is a curved strip plate that fits above the large sciatic notch. The reduction plate consists of the first plate, the second plate, the third plate, and the T-type auxiliary plate. The first plate is bent to fit the anatomical structure above the acetabulum, the second plate intersects with the locking plate, the third plate is bent to fit the anatomical structure of the acetabular quadrilateral body, and the T-type auxiliary plate is molded integrally with the first plate and fixed to the anterior column of the acetabulum (shown in Figure 1). This fixation system has been granted a Chinese Patent (Patent No. CN202210974276.4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, this fixation system must be shaped based on the characteristics of the acetabulum and the surgeon\u0026rsquo;s experience. For inexperienced surgeons, poor precision of intraoperative plate shaping may lead to a loss of reset. To achieve a standard for the combined reduction anatomical steel plate with higher precision, a better fit to the pelvic surface anatomical structure, a reduction in operation time, and an improvement in therapeutic effect are required; therefore, this study utilized a three-dimensional (3D) model of the pelvis, measured the anatomical morphology parameters of the bone surface on the fixation path of this fixation system, and summarized the features of the plate to design and develop an anatomical steel plate with higher precision and in line with the pelvic structure of the Chinese population.\u003c/p\u003e"},{"header":"2. Materials And Methods","content":"\u003cp\u003eWe collected data from adult patients who underwent pelvic CT+3D at the affiliated hospital of Zuni Medical University between January 2022 and January 2023. A total of 102 cases of partial pelvic data were obtained, including 51 males with an age range of 22\u0026ndash;60 years and an average age of 44.37 years, and 51 females with an age range of 23\u0026ndash;60 years and an average age of 47.88 years. The age difference was not statistically significant (P\u0026gt;0.05). In this study, all patients were required to meet the following inclusion criteria: no lesions, fractures, tumors, or anatomical abnormalities on one or both sides of the pelvis and age between 20\u0026ndash;60 years.\u003c/p\u003e\n\u003cp\u003eAll CT data were acquired using a 64-channel helical CT scanner with a slice thickness of 1 mm, and were saved in DICOM format. The DICOM CT data were imported into Mimics 21.0 (Materialise Company, Leuven, Belgium). Then, through threshold segmentation, region growing, and smoothing to remove soft tissue, a 3D pelvic model was reconstructed and saved in STL format. The STL-format pelvic 3D model was further processed using 3-matic software for wrapping, smoothing, and mesh reduction to obtain a standardized pelvic 3D model (Figure 2).\u003c/p\u003e\n\u003cp\u003eThe fixation trajectory of the combined reduction and anatomical plate was drawn. The proximal end of the reduction plate started from the anterior inferior iliac spine, followed the posterior wall of the acetabulum, and extended to the distal end until a third of the way down the line between the greater ischial notch and the ischial spine, which was at the projection point on the fixation trajectory. It then curved to the quadrilateral body. The reduction plate and T-type auxiliary plate were fixed to the anterior column of the acetabulum. The locking plate began 1 cm below the anterior inferior iliac spine, parallel to the reduction plate, and extended distally to the apex of the ischial tuberosity (as shown in Figure 1). The Trim command under the Finish function list in the 3-matic software was used to create the profile that crossed the centerline of the steel plate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe fixation trajectory of the reduction plate can be considered as five arcs with the radii of curvature of the ilium (r1), posterior wall (r2), ischium (r3), quadrilateral area (r4), and bending area (r5). The radius of curvature of the locking plate can be divided into four arcs: the iliac region (R1), proximal posterior wall (R2), posterior wall region (R3), and distal posterior wall (R4). The fixed trajectory of the T-shaped auxiliary plate can be regarded as two arcs with radii of curvature at the posterior superior iliac spine side (r6) and the anterior superior iliac spine side (r7) (as shown in Figure 3). Each arc was fitted using the software, and the diameter and length of the circle were measured directly using the software. The arc length of each arc can be calculated by the formula \u003csup\u003e[18]\u003c/sup\u003e: arc length = diameter \u0026times; (arc in chord length/diameter), and the length of the plate was obtained by summing the arc lengths. Simultaneously, the degree of bending of the reduction plate to the square was measured (\u0026lt; A \u0026deg;) using the measuring tool in the software.\u003c/p\u003e"},{"header":"3. Data analysis","content":"\u003cp\u003eSPSS 29.0 (IBM Corp., Armonk, NY, USA, Version 29.0) was used to process and analyze the data. All data were expressed as mean \u0026plusmn; standard deviation (SD). Differences were considered statistically significant at P\u0026lt;0.05.\u003c/p\u003e"},{"header":"4. Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e4.1 Comparison of the length of each section and the total length of the reduction plate between males and females\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, hemipelvic data were obtained from 51 males aged 22\u0026ndash;60 years, with an average age of 44.37 years. The average arc lengths of r1, r2, r3, r4, and r5 were 54.09 \u0026plusmn; 5.30 mm (42.74\u0026ndash;67.26 mm), 34.34 \u0026plusmn; 4.57 mm (24.92\u0026ndash;45.80 mm), 30.54 \u0026plusmn; 2.99 mm (26.38\u0026ndash;37.92 mm), 25.39 \u0026plusmn; 4.11 mm (14.61\u0026ndash;33.68 mm), and 7.77 \u0026plusmn; 1.73 mm (4.52\u0026ndash;13.82 mm), respectively, with a total length of 151.70 \u0026plusmn; 11.55 mm (125.25\u0026ndash;178.21 mm). In addition, hemipelvic data were obtained from 51 females aged 23\u0026ndash;60 years, with an average age of 47.88 years. The average arc lengths of r1, r2, r3, r4, and r5 were 53.80 \u0026plusmn; 3.90 mm (47.01\u0026ndash;68.78 mm), 32.48 \u0026plusmn; 4.73 mm (23.98\u0026ndash;44.93 mm), 26.97 \u0026plusmn; 3.20 mm (21.25\u0026ndash;34.30 mm), 22.39 \u0026plusmn; 3.87 mm (13.15\u0026ndash;31.17 mm), and 6.35 \u0026plusmn; 1.70 mm (3.22\u0026ndash;11.84 mm), respectively, with a total length of 141.99 \u0026plusmn; 8.94 mm (117.56\u0026ndash;158.19 mm). The statistical results indicate that there was no significant difference in the arc length of r1 between males and females (P\u0026gt;0.05); however, the arc lengths of r2, r3, r4, and r5, and the total length of the reduction plate in females were significantly shorter than those in males (P\u0026lt;0.05; Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Comparison of the length of each zone and the total length of the reduction plate trajectory between males and females (mm, mean \u0026plusmn; standard deviation)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.29641185647426%\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.928237129485179%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003eIliac \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(r1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003ePosterior wall (r2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003eIschial\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(r3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003eQuadrilateral (r4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003eBending zone (r5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003eTotal length\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.29641185647426%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.928237129485179%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e54.095.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e34.34\u0026plusmn;4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e30.54\u0026plusmn;2.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e25.39\u0026plusmn;4.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e7.77\u0026plusmn;1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e151.70\u0026plusmn;11.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.29641185647426%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.928237129485179%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e53.80 \u0026plusmn;3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e32.48\u0026plusmn;4.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e26.97\u0026plusmn;3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e22.39\u0026plusmn;3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e6.35\u0026plusmn;1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e141.99\u0026plusmn;8.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.29641185647426%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.928237129485179%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e2.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e5.834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e3.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e4.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e4.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.29641185647426%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.928237129485179%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.260530421216849%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.664586583463338%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\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\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e4.2 Comparison of length of each zone and total length of the locking plate between males and females\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe average arc lengths of R1, R2, R3, and R4, and the total arc length in the 51 males were 36.61 \u0026plusmn; 5.12 mm (24.86\u0026ndash;47.66 mm), 14.06 \u0026plusmn; 2.98 mm (7.80\u0026ndash;21.37 mm), 32.62 \u0026plusmn; 4.61 mm (19.50\u0026ndash;43.78 mm), 32.18 \u0026plusmn; 4.95 mm (21.33\u0026ndash;45.19 mm), and 115.46 \u0026plusmn; 8.82 mm (96.63\u0026ndash;134.84 mm), respectively. The average arc lengths of R1, R2, R3, and R4, and the total arc length in the 51 females were 36.55 \u0026plusmn; 5.18 mm (25.58\u0026ndash;53.87 mm), 14.93 \u0026plusmn; 3.43 mm (4.59\u0026ndash;20.17 mm), 30.29 \u0026plusmn; 4.46 mm (21.00\u0026ndash;43.09 mm), 26.84 \u0026plusmn; 4.44 mm (17.39\u0026ndash;38.43 mm), and 108.61 \u0026plusmn; 7.26 mm (93.70\u0026ndash;123.13 mm), respectively.The statistical results indicate that there was no significant difference in the arc lengths of R1 and R2 between males and females (P\u0026gt;0.05); however, the arc lengths and the total length of the locking plate for R3 and R4 in females were significantly shorter than those in males (P\u0026lt;0.05; Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Comparison of the length of each zone and the total length of the locking plate trajectory between males and females (mm, mean \u0026plusmn; standard deviation)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.458333333333334%\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.597222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.756944444444445%\" valign=\"top\"\u003e\n \u003cp\u003eIliac\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(R1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.055555555555557%\" valign=\"top\"\u003e\n \u003cp\u003eProximal to posterior wall (R2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003ePosterior wall (R3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003eDistal to the posterior wall (R4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003eTotal length\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.597222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.756944444444445%\" valign=\"top\"\u003e\n \u003cp\u003e36.61\u0026plusmn;5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.055555555555557%\" valign=\"top\"\u003e\n \u003cp\u003e14.06\u0026plusmn;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003e32.62\u0026plusmn;4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003e32.18\u0026plusmn;4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003e115.46\u0026plusmn;8.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.597222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.756944444444445%\" valign=\"top\"\u003e\n \u003cp\u003e36.55\u0026plusmn;5.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.055555555555557%\" valign=\"top\"\u003e\n \u003cp\u003e14.93\u0026plusmn;3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003e30.29\u0026plusmn;4.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003e26.84\u0026plusmn;4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003e108.61\u0026plusmn;7.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.597222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.756944444444445%\" valign=\"top\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.055555555555557%\" valign=\"top\"\u003e\n \u003cp\u003e1.366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003e2.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003e5.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003e4.286\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.597222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.756944444444445%\" valign=\"top\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.055555555555557%\" valign=\"top\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.493055555555557%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.319444444444443%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\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\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e4.3 Comparison of the sectional length, total length, and bending angle (\u0026lt; A \u0026deg;) between males and females\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe average values of the arc length, corresponding to r6 and r7, total length, and bending angle (\u0026lt; A \u0026deg;) in the 51 male pelvic T-shaped auxiliary steel plates were \u0026nbsp;28.16 \u0026plusmn; 5.17 mm (18.42\u0026ndash;42.31 mm), 46.50 \u0026plusmn; 5.37 mm (33.97\u0026ndash;62.22 mm),74.67 \u0026plusmn; 6.81 mm (57.62\u0026ndash;85.17 mm), and 83.58 \u0026plusmn; 13.99\u0026deg; (56.63\u0026ndash;114.79\u0026deg;), respectively. In the 51 female pelvic T-shaped auxiliary steel plates, the average values of the arc length, corresponding to r6 and r7, total length, and bending angle (\u0026lt; A \u0026deg;) were 27.09 \u0026plusmn; 5.40 mm (15.28\u0026ndash;39.83 mm), 42.61 \u0026plusmn; 5.51 mm (23.94\u0026ndash;53.96 mm),69.70 \u0026plusmn; 6.82 mm (51.40\u0026ndash;88.08 mm), and 71.99 \u0026plusmn; 14.74\u0026deg; (42.06\u0026ndash;104.71\u0026deg;). The statistical analysis indicated no significant difference (P\u0026gt;0.05) in the arc length of r6 between males and females, while the arc length of r7 and the total length of the T-shaped auxiliary plate in females were significantly smaller than those in males (P\u0026lt;0.05). The bending angle (\u0026lt; A \u0026deg;) in females was also significantly smaller than in males (P\u0026lt;0.05; Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Comparison of sectional length, total length, and bending angle (mm, \u0026deg;, mean \u0026plusmn; standard deviation)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.73076923076923%\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.538461538461538%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003ePosterior superior iliac spine side (r6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eAnterior superior iliac spine\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(r7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.692307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eTotal length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003eBending angle\u003c/p\u003e\n \u003cp\u003e(\u0026lt; A\u0026nbsp;\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.538461538461538%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e28.16\u0026plusmn;5.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e46.50\u0026plusmn;5.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.692307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e74.67\u0026plusmn;6.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e83.58\u0026plusmn;13.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.538461538461538%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e27.09\u0026plusmn;5.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e42.61\u0026plusmn;5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.692307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e69.70\u0026plusmn;6.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e71.99\u0026plusmn;14.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.538461538461538%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e1.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e3.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.692307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e3.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e4.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.538461538461538%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.692307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.576923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"5. Discussion","content":"The combined reduction anatomical plate in this study is an anatomical plate, it can significantly reduce the difficulty of shaping the plate during operation, and creatively realize the single posterior K-L approach can solve the difficulties of traditional combined approaches for the treatment of complex acetabular fractures, which is convenient for operation and improves prognosis. However, this study has some limitations. For example, our measurements were representative of specific populations and may not be generalizable to all races. Typically, pelvic anatomy varies greatly depending on the geographical location and population. Previous studies have shown a decreasing trend in pelvic size from high to low latitudes.[30] In addition, the different physiological functions of men and women determine morphological differences in the pelvis.[31] In the software measurement process, errors caused by human factors are inevitable when the landmarks are determined. Additionally, screws were not considered in this study, and in a follow-up study, we will further optimize them to improve the treatment effect."},{"header":"6. Conclusions","content":"\u003cp\u003eIn this study, digital technology was used to measure the fixation trajectory of a combined anatomical reduction plate, which provided an anatomical basis for plate design. Simultaneously, it overcomes the shortcomings of traditional cadaveric bone samples and large measurement errors. Although the anatomical plate we designed could not meet the anatomical structure of all populations, its accuracy was higher than that of traditional reconstruction plates. It can be used to treat quadrilateral acetabular fracture. so that the treatment methods become diversified. In addition, it can reduce the time required to shape the plate, operative time, bleeding, and the surgical risk. Finally, the clinical outcomes of the fixation devices used in this study will be investigated in future studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis study was approved by the Institutional Review Board of the Affiliated Hospital of Zunyi Medical University, Zunyi, Guizho, China.All subjects provided informed consent to take part in the study. All procedures were conducted according to the 1964 Declaration of Helsinki and its amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicting of interests:\u003c/strong\u003e All authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eAll authors declare no financial interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eBao CS: Data measurement, data analysis, main contributors to writing the paper.Yan XH, He L ,Yao QS :Participated in study conception, supervised data measurement, and data analysis . Chen L and Ao J Participated in study design, data analysis, and paper revision. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe datas used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of the Affiliated Hospital of Zunyi Medical University, Zunyi, Guizho, China, Ethics number KLLY-2022-017. All subjects provided informed consent to take part in the study. All procedures were conducted according to the 1964 Declaration of Helsinki and its amendments.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMatta JM. 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Fixation of quadrilateral plate fractures of the acetabulum using the buttress screw: A novel technique. \u003cem\u003eInjury\u003c/em\u003e 2017; 48: 1813\u0026ndash;1818.\u003c/li\u003e\n\u003cli\u003eChen K, Yang F, Yao S, et al. Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly: The Role of Special Quadrilateral Surface Buttress Plates. \u003cem\u003eJ Bone Joint Surg Am\u003c/em\u003e 2020; 102: e81.\u003c/li\u003e\n\u003cli\u003eShang R, Wu H, Zhou L, et al. Third-Generation Dynamic Anterior Plate-Screw System for Quadrilateral Fractures: Digital Design Based on 834 Pelvic Measurements. \u003cem\u003eMedicina (Kaunas)\u003c/em\u003e 2023; 59.\u003c/li\u003e\n\u003cli\u003eZhang S, Su W, Luo Q, et al. Measurement of the \u0026quot;safe zone\u0026quot; and the \u0026quot;dangerous zone\u0026quot; for the screw placement on the quadrilateral surface in the treatment of pelvic and acetabular fractures with Stoppa approach by computational 3D technology. \u003cem\u003eBiomed Res Int\u003c/em\u003e 2014; 2014: 386950.\u003c/li\u003e\n\u003cli\u003eGuo J, Dong W, Zhou Y, et al. Differences in fixation to young and elderly quadrilateral surfaces with anatomic quadrilateral surface plate (AQSP) based on cortical thickness morphological results. \u003cem\u003eJ Orthop Surg Res\u003c/em\u003e 2022; 17: 143.\u003c/li\u003e\n\u003cli\u003eChinese Medical Association Orthopaedic Society, Chinese Medical Doctor Association Orthopaedic Society, Pelvic Acetabular Injury Division, Chinese International Exchange and Promotion Association for Medical and Healthcare, et al. Guideline for clinical diagnosis and treatment of acetabular quadrilateral body fractures (2023). Chinese Journal of Bone and Joint Surgery 2023; 16: 481\u0026ndash;492.\u003c/li\u003e\n\u003cli\u003ePrasartritha T, Chaivanichsiri P. The study of broken quadrilateral surface in fractures of the acetabulum. \u003cem\u003eInt Orthop\u003c/em\u003e 2013; 37: 1127\u0026ndash;1134.\u003c/li\u003e\n\u003cli\u003eLiu Q, Zhang K, Zhuang Y, et al. A morphological study of anatomical plates for acetabular posterior column. \u003cem\u003eInt J Comput Assist Radiol Surg\u003c/em\u003e 2014; 9: 725\u0026ndash;731.\u003c/li\u003e\n\u003cli\u003eWu X, Chen W, Zhang Q, et al. The study of plate-screw fixation in the posterior wall of acetabulum using computed tomography images. \u003cem\u003eJ Trauma\u003c/em\u003e 2010; 69: 423\u0026ndash;431.\u003c/li\u003e\n\u003cli\u003eWu H, Shang R, Cai X, et al. Single Ilioinguinal Approach to Treat Complex Acetabular Fractures with Quadrilateral Plate Involvement: Outcomes Using a Novel Dynamic Anterior Plate-Screw System. \u003cem\u003eOrthop Surg\u003c/em\u003e 2020; 12: 488\u0026ndash;497.\u003c/li\u003e\n\u003cli\u003eLichte P, Sellei RM, Kobbe P, et al. Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study. \u003cem\u003ePatient Saf Surg\u003c/em\u003e 2013; 7: 9.\u003c/li\u003e\n\u003cli\u003eZiran N, Soles GLS, Matta JM. Outcomes after surgical treatment of acetabular fractures: a review. \u003cem\u003ePatient Saf Surg\u003c/em\u003e 2019; 13: 16.\u003c/li\u003e\n\u003cli\u003eJaikirty R, Homa A, Peter B. Surgical stabilization of acetabular injuries: approaches and methods. \u003cem\u003eOrthopaedics and Trauma\u003c/em\u003e 2022(prepublish).\u003c/li\u003e\n\u003cli\u003eGuerado E, Cano JR, Cruz E. Simultaneous ilioinguinal and Kocher-Langenbeck approaches for the treatment of complex acetabular fractures. \u003cem\u003eHip Int\u003c/em\u003e 2010; 20 Suppl 7: S2-10.\u003c/li\u003e\n\u003cli\u003eDelprete H. Pelvic Inlet Shape Is Not as Dimorphic as Previously Suggested. \u003cem\u003eAnat Rec (Hoboken)\u003c/em\u003e 2017; 300: 706\u0026ndash;715.\u003c/li\u003e\n\u003cli\u003eColeman WH. Sex differences in the growth of the human bony pelvis. \u003cem\u003eAm J Phys Anthropol\u003c/em\u003e 1969; 31: 125\u0026ndash;151.\u003c/li\u003e\n\u003c/ol\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":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"acetabular fracture, quadrilateral region, reduction and internal fixation, digital measurement","lastPublishedDoi":"10.21203/rs.3.rs-3993761/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3993761/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eTo digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to develop anatomical plates that align with the characteristics of the pelvis in the Chinese population.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003ePelvic computed tomography (CT) data from 102 adult patients were collected at the Affiliated Hospital of Zunyi Medical University. This group included 51 males and 51 females, aged between 20–60 years. Using Mimics software (version 21.0), a three-dimensional model of each pelvic data point was reconstructed. The fixation path for the combined reset anatomical steel plate was drawn, where the curves on the fixation path were approximated as arcs. The radius of curvature and length of these curves were measured, and an anatomical steel plate was designed to best fit the pelvic structure.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eThe combined anatomical reduction plate fixation system for quadrilateral acetabular fractures using a posterior approach consisted of two parts: a locking plate and a reduction plate. The posterior wall region (r2), ischial region (r3), quadrilateral region (r4), and bending region (r5), and the total length of the reduction plate were significantly smaller in females (P\u0026lt;0.05). Similarly, the posterior wall region (R3), distal posterior wall region (R4), and the total length of the locking plate were significantly smaller in females (P\u0026lt;0.05). Additionally, the anterior superior iliac spine side (r1) and the total length of the T-shaped auxiliary plate were significantly smaller in females (P\u0026lt;0.05). The bending angle (\u0026lt;A) was also significantly smaller in females (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eThe combined reduction anatomical plate designed in this study demonstrated high precision and improved conformity to the anatomical structure of the pelvis. This design reduces the difficulty of plate shaping during surgery, decreases operative time, and facilitates clinical application.\u003c/p\u003e","manuscriptTitle":"Combined anatomical reduction plate for quadrilateral acetabular fractures via a posterior approach: An anatomical–morphological study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-05 17:41:27","doi":"10.21203/rs.3.rs-3993761/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-12T05:10:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-01T09:06:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1ac15273-a7cd-498e-b627-1b5260add63e","date":"2024-03-30T11:05:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-17T11:28:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0a4421f4-6866-4dae-8079-aa174998c2cd","date":"2024-03-02T16:44:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"06c9b14e-98c8-488c-b5c5-31c29dc4193d","date":"2024-03-02T10:04:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-02T08:53:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-02T08:46:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-01T17:23:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-01T14:34:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2024-02-27T11:30:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce5fcbf0-da89-4e8d-a70c-a05bfa460804","owner":[],"postedDate":"March 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-14T09:02:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-05 17:41:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3993761","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3993761","identity":"rs-3993761","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}