Objectives. Acetabular fractures with quadrilateral plate involvement have been shown to have a high rate of complications. Anatomic suprapectineal plating systems have been developed to manage these injuries with good short-term outcomes, however long-term maintenance of anatomical reduction and functional outcomes is yet to be established. Efficacy of maintenance of reduction and functional outcomes at a minimum of 5-years follow-up is the aim of this study. Design and Methods. A retrospective cohort study examining patients aged over 16 years following fixation of acetabular fractures with quadrilateral plate involvement at a trauma centre in the United Kingdom. All patients had acetabular fracture fixation with an anatomically designed suprapectineal plate. Patients were admitted from March 2014 to January 2017. Primary outcomes included objective radiological outcomes such as reduction quality, maintenance of reduction, metalwork failure, complications (such as reoperation, neurological deficit and mortality) and subjective patient-related outcome measures (PROMs) using the Oxford Hip Score and EuroQol EQ5D Score at a minimum of 5-years post-operatively. Results. 16 patients met our eligibility criteria in this cohort. Post-operative mean Oxford Hip Score (OHS) at a minimum of 5-years was 40.5 (SD 11.9) with a median score of 45. Post-operative mean EuroQol EQ-5D scores at a minimum of 5-years were 0.83 (SD 0.25). Comparison of OHS and EQ5D at 1-year and 5-years showed no significant difference (OHS p = 0.27 / EQ5D p = 0.128). Radiographic outcomes were assessed with AP and Judet plain radiographs at a minimum of 5-years follow-up. Rate of conversion to total hip replacement was 6.25%. 56.3% showed some evidence of dome comminution with 18.8% demonstrating dome impaction. 93.7% showed evidence of quadrilateral plate involvement. 12.5% showed evidence of femoral head injury. Conclusion. Maintenance of reduction and functional and patient reported outcomes using anatomically contoured suprapectineal plates do not change significantly between 1 year and 5 years follow-up

Operative approaches to the acetabulum are generally classified into anterior, posterior, extensile or combined approaches. The choice of approach depends upon the fracture pattern and the amount of relative displacement affecting the anterior and posterior bony structures. Occasionally, extensile or combined surgical approaches are indicated for the treatment of complex fracture patterns with extensive involvement of both the anterior and posterior acetabular anatomy. However, it is believed that these approaches may be associated with higher complication rates than more limited surgical approaches. The ilioinguinal approach described by Letournel is routinely employed in the treatment of anterior column, anterior wall, anterior column/posterior hemi- transverse and certain associated both-columns, transverse and T-type fractures. The utility of this approach is sometimes limited by difficulty in visualising, reducing and applying instrumentation to the quadrilateral plate and posterior column components of these fractures. A surgical approach described by Stoppa in 1989—and later extended to acetabular indications by Cole and Bolhofner—can be used, often in combination with the lateral window of the standard ilioinguinal approach, to effectively treat the same range of fractures as an ilioinguinal approach. Access to the quadrilateral plate and certain displaced posterior column fracture lines is enhanced by this approach—possibly eliminating the need for combined or extensile approaches in certain cases. A retrospective study undertaken at our institution demonstrated that anatomic articular reduction was achieved in 14 of 17 complex acetabular fractures treated via a Stoppa approach. All fractures in the study had at least 5 mm of posterior column displacement preoperatively

Stoppa approach has recently been adapted for pelvic surgery as it allows direct intra-pelvic reduction and fixation of the quadrilateral plate and anterior column. We report our early experience, indications and complications with this exposure introduced in 2010 in our tertiary unit. A Retrospective review of all Stoppa approaches in pelvic-acetabular fixations was performed from a prospectively maintained database. Of the 25 patients, mean age 40 years (range 15–76), who underwent pelvic-acetabular fixation using Stoppa approach, 21 patients had mean follow up of 7.3 months (1–48 months). All except 24% of patients had one or more additional systemic injury some requiring additional surgery. There were 6 acetabular fractures, 13 pelvic ring injuries and 6 combined fractures. Mean injury-surgery interval was 9 days (range 3–20). 8 patients had an isolated Stoppa approach whilst the remaining others also had an additional approach. Mean surgical time was 239 minutes. Anatomical reduction was achieved in 96% (24/25) cases. There was 1 minor intra-operative vascular injury, repaired immediately successfully, and no late wound infections, or other visceral complications. One patient reported new onset sensory numbness which resolved after the first review. Two patients reported erectile dysfunction thought to be caused by the initial injury. One patient had asymptomatic plate loosening. None required revision surgery. Despite the obvious learning curve, we found this approach safe and it did not compromise accuracy of reduction in well selected patients, but early surgery within 10–14 days is recommended to aid optimal reduction