title: The use of buttress plates in the management of acetabular fractures with quadrilateral plate involvement: is it still a valid option?
abstract: OBJECTIVE
  The primary aim of this study was to report on the mid-term outcomes after quadrilateral plate reconstruction of acetabular fractures using a buttress/spring plate through an ilioinguinal approach.
  
  
  METHODS
  Between 2003 and 2011, 30 adult patients (25 males) with mean age 54 years (range 17-80) who underwent surgical fixation for an acetabular fracture and had minimum follow up of 24 months (mean 46.2, range 24-78.6) were retrospectively reviewed. Standard demographics, admission and hospitalization data (concomitant injuries, number of operative procedures, time to operating theatre, early and late complications) were correlated to the clinical (Harris Hip Score) and radiological (Matta Reduction Score and Matta Arthritis Score) outcome.
  
  
  RESULTS
  Three patients underwent a Total Hip Replacement. Functional score was excellent in 17 (56.6 %), good in 4 (13.3 %), fair in 6 (20 %) and poor in 3 (10 %) cases. Surgery-related complications included two patients with temporary lateral femoral cutaneous palsy and three with heterotopic ossification. The quality of the postoperative reduction was associated to Harris Hip Score (p = 0.015) and postoperative arthritis (p = 0.010). Strong association was evident between age and both post-operative reduction (p = 0.010) and arthritis (p = 0.014). The presence of quadrilateral plate comminution and gull-sign were associated to poor post-operative reduction (p = 0.016) and low Harris Hip Score (p = 0.049) respectively.
  
  
  CONCLUSIONS
  Quadrilateral plate reconstruction with a buttress plate though the ilioinguinal approach remains a valid method of fixation in acetabular surgery. Additional studies are needed to compare the efficiency of this method to new surgical approaches and fixation implants.
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, UK.|NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA, West Yorkshire, Leeds, UK.
authors.forename: Theodoros H
authors.initials: TH
authors.lastname: Tosounidis
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, UK.
authors.forename: Suribabu
authors.initials: S
authors.lastname: Gudipati
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, UK.
authors.forename: Michalis
authors.initials: M
authors.lastname: Panteli
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, UK.
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Kanakaris
authors.affiliation: Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, UK. pgiannoudi@aol.com.|NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA, West Yorkshire, Leeds, UK. pgiannoudi@aol.com.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Acetabular fracture; Acetabular reconstruction; Buttress/spring plate; Ilioinguinal approach; Quadrilateral plate