Results of Suprapectineal Plating for Displaced Quadrangular Plate Acetabular Fractures

Complex acetabular fractures involving the quadrilateral plate are challenging to treat. Rigid, stable, anatomic fixation using implants like the supra-pectineal plate has shown promising results even with poor bone quality and severe comminution. However, there is no consensus on the optimal implant choice for these fractures. Our study across 2 Major Trauma Centres (MTC's) in the Greater Manchester region between 2020–2025 retrospectively reviewed 30 patients treated with supra-pectineal plating for displaced quadrilateral plate fractures using the modified Stoppa approach. Peri and post-operative results (minimum follow-up of 12 months) were evaluated for quality of reduction, time to union, functional recovery, peri-operative complications and development of post-traumatic arthritis. Objective evaluation was done using Oxford Hip Score (OHS). Out of the 30 patients, 60%(n=18) were male and the group had a median age of 55 years (range 22–88 years). Median length of hospital stay was 17.5 days. While 93% (n=28) patients had satisfactory to good post -op reduction (CT/X-Ray), reduction quality was deemed poor in 7% (n=2) patients. Average time to confirmed radiological union was 6.25 months. OHS was calculated for 29 patients of which 17% (n=5) reported severe symptoms (OHS 0 to 19), 4% (n=1) reported moderate to severe symptoms (OHS 20 to 29), 43% (n=13) had mild to moderate symptoms (OHS 30 to 39), and 35% (n=10) reported satisfactory joint function (OHS 40 to 48). Failure of metalwork was reported in one patient. Thus, in our cohort of patients, supra-pectineal plating provided satisfactory hip function post-op for majority of the patients with an OHS >30 and good reduction was achieved in 93% of our cohort as confirmed by post-op imaging.