Mini-fragment plate fixation seen as ‘another tool’ for challenging fractures
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Use of mini-fragment plates may be effective for the provisional fixation of elementary and associated acetabular fractures, according to an orthopedic trauma specialist.
Steven F. Shannon, MD, and colleagues from the R Adams Cowley Shock Trauma Center analyzed the efficacy of mini-fragment plate fixation in 57 patients with associated (n = 49) and elementary (n = 8) acetabular fractures in their clinical and technical series from 2013 to 2018.
According to the study, 16 patients required two plates, two patients required four plates and one patient required six plates. Of the 68 plates used throughout the study, the 2.7-mm plate was most commonly used, followed by the 2.4-mm plate and the 2-mm plate.
Overall, Shannon and colleagues found 77% of patients (n = 44) had excellent reduction quality using the mini-fragment plates. Additionally, 19.3% of patients had fair reduction quality and 3.5% of patients had poor reduction quality.
“We hope our technique of utilizing provisional mini-fragment plates becomes another tool in the armamentarium of acetabular surgeons for addressing challenging fractures,” Shannon told Healio Orthopedics. “This technique can also be applied to other difficult fractures traumatologists may encounter in the lower and upper extremities,” he said.
“The future implications of this work will be to present further data about our experiences with these techniques applied to the lower and upper extremities fractures including pilon, plateau, distal femur, distal humerus and trans-olecranon fracture dislocations,” Shannon concluded.
Perspective
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Cyril Mauffrey, MD, FACS, FRCS
The study by Shannon and colleagues recently published in the Journal of Orthopaedic Trauma successfully highlights the use of provisional mini-fragment plates and screws in simple and associated fractures of the acetabulum. While the technique is not novel, it deserves particular attention because it mitigates some of the challenges encountered during open reduction and internal fixation of acetabular fractures: 1) clamps in the way of plate fixation; 2) the use of stiff constructs that are inadequately contoured, provoking subtle displacement of the acetabular fracture during screw tightening; 3) flexibility of a column, allowing fixation of the other column without compromising the ability of reduction; and 4) better compression and absolute stability to enhance primary bone healing.
The authors should be commended for their work. A couple of technical pearls pertinent to this technique deserve to be added.
In fractures that are more likely to develop post-traumatic arthritis and require an arthroplasty, I avoid placing hardware in close proximity to the joint to circumvent the need of hardware removal.
The technique of mini-fragment plate application around the posterior pelvic brim can be a meticulous technical challenge. I like to drill a screw hole without the plate in situ, measure desired screw length and place the screw through the plate ex-vivo before introducing the plate screw construct as a unit.
Reference:
Alfonso NA, et al. J Orthop Trauma. 2020;doi:10.1097/BOT.0000000000001637.
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