Fixation of Superomedially Displaced Acetabular Fractures Using an Anatomical Suprapectineal Quadrilateral Surface Plate Through Modified Stoppa Approach

Treatment of superomedially displaced acetabular fractures including a quadrilateral surface (QLS) is challenging. We present a surgical technique using an anatomical suprapectineal QLS plate through the modified Stoppa approach and report the availability of this plate to treat this fracture type along with the surgical outcomes. Thirteen consecutive patients (11 men and 2 women) who underwent surgical treatment using an anatomical suprapectineal QLS plate through a modified Stoppa approach for superomedially displaced acetabular fractures between June 2018 and June 2020, were enrolled retrospectively. These fractures included 10 both-column fractures and 3 anterior-column and posterior hemitransverse fractures, which were confirmed on preoperative 3-dimensional computed tomography. Surgical outcomes were clinically assessed using the Postel Merle d’Aubigné (PMA) score and visual analog scale (VAS) score at the final follow-up, and radiological evaluations were performed immediately after the operation and at the final follow-up. The follow-up period was longer than 1 year in all patients with a mean 22.9 months. The mean operation time was 103 min. Anatomical reduction was achieved in 11 (84.6%) patients, while imperfect reduction was achieved in the remaining two (15.3%) patients. At the final follow-up, radiographic grades were excellent, fair, and poor in 11 (84.6%), one (7.6%), and one patient, respectively. The mean PMA score was 16.3 (range, 13-18) and the mean VAS score was 1.0 (range, 0-3). No secondary reduction loss or implant loosening was observed. However, two patients underwent conversion to total hip arthroplasty due to post-traumatic arthritis and subsequent joint pain. No other complications were observed. Simultaneous reduction and fixation using an anatomical suprapectineal QLS plate through the modified Stoppa approach can provide satisfactory outcomes in superomedially displaced acetabular fractures, resulting in shorter operation times and fewer complications.