Biaxial reduction technique for the medially displaced quadrilateral surface in acetabular fracture through the modified iliofemoral approach: An observational study

Treatment of acetabular fractures is technically demanding injuries. The complex surgical approaches and special equipment have been introduced for achieving accurate anatomical reduction. The aim of the study was to present our experiences of using a newly operative technique to achieve accurate reduction of articular dome impaction and of the quadrilateral surface without special equipment or traction device in reference to fracture reduction and fixation, technical aspects, and the incidence of complications. Five acetabular fractures with involvement of the quadrilateral plate associated anterior column and posterior hemi-transverse fractures were treated with an anatomically curved reconstruction plate and 2 lag screws using a biaxial reduction technique with a modified iliofemoral approach. The impacted quadrilateral plate was reduced without special equipment with accurate reduction of the articular surface by direct digital palpation in an extensive working space. Fracture reduction was assessed by Matta radiographic scoring as anatomic (within 1 mm) or satisfactory reduction (between 1 and 3 mm) in all 5 cases. Functional outcomes, according to the Harris hip score system, were greater than 90 points in all 5 patients. No loss of reduction, joint penetration, or visceral and neurovascular injury was documented at 1-year follow-up. The biaxial reduction technique with a modified iliofemoral approach provides a versatile method for fracture fixation and greater surgical access in medial impacted dome injury with comminuted anterior AC fracture without special equipment or traction device. Observational study, level IV