We describe our early operative experience with a new pelvic reduction frame and the standard of reduction of fractures of the pelvic ring which we achieved in the first 35 consecutive patients, with 34 acute fractures and one nonunion. The pre-operative and immediate post-operative radiographs were measured, using two methods, to find the maximum radiological displacement of the fracture and the quality of the reduction according to the criteria of Tornetta and Matta. There were 19 vertical shear fractures and 16 compression injuries. The mean age of the patients was 33.5 years (10 to 59) and mean delay to surgery was 4.6 days (0 to 16) in the 34 acute injuries. The mean operative time in isolated procedures was 103.4 minutes (. sd. 6.5). All but one patient had iliosacral screws implanted, 18 had screws in the anterior column, six had plates at the symphysis pubis and 12 had anterior external fixators. The mean maximum horizontal or vertical displacement was improved from 30.8 mm (. sd. 2.7) to a mean of 7.1 mm (. sd. 0.7). The reduction was assessed as excellent in ten patients, good in 18, and fair in the remainder. There was no significant influence on the quality of the reduction caused by obesity (p = 0.34), the type of fracture (p = 0.41) or delay to surgery (p = 0.83). The frame was shown to be effective, allowing the surgeon to obtain a satisfactory reduction and fixation of acute displaced disruptions of the pelvic ring

Background. The usefulness of arthroscopic reduction for the intra-articular fracture of the distal radius has been reported, although it is technically difficult. Hypothesis. Our hypothesis is that the reduction using the external fixator is useful as equivalent to the arthroscopic reduction for the intra-articular fracture of the distal radius fracture in the fixation with the volar locking plate. Materials & Methods. The surgery was performed in both methods randomly for 40 patients; average age 64(24 to 92) years, 11 male, 29 female. Image evaluations were performed at 24 weeks after surgery. Ulnar variance, Radial inclination, Volar tilt in the X-ray image, and gap and step in the computed tomogram were evaluated. Clinical evaluation was performed at 6, 12, 24 weeks after surgery. Objective evaluations were ranges of motion and grip strength. Subjective evaluations were disabilities of the arm, shoulder, and hand (DASH). Results. The results of image and objective evaluation had no significant difference between the two groups. DASH in arthroscopic group was significantly inferior at 24 weeks because of minor complications. Discussion & Conclusion. The external fixator and the arthroscopy are equally valuable in reduction of articular surface

Aims. Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation. Methods. A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated ankle fracture (n = 40), pilon fracture (n = 20), and intra-articular calcaneal fracture (n = 40). Patients were randomized to the two study groups in a 1:1 ratio. The effectiveness of VIT (intervention) compared with elevation (control) was analyzed separately for the whole study population and for the three subgroups. The primary endpoint was the time from admission until operability (in days). Results. The mean length of time until operability was 8.2 days (SD 3.0) in the intervention group and 10.2 days (SD 3.7) in the control group across all three fractures groups combined (p = 0.004). An analysis of the subgroups revealed that a significant reduction in the time to operability was achieved in two of the three: with 8.6 days (SD 2.2) versus 10.6 days (SD 3.6) in ankle fractures (p = 0.043), 9.8 days (SD 4.1) versus 12.5 days (SD 5.1) in pilon fractures (p = 0.205), and 7.0 days (SD 2.6) versus 8.4 days (SD 1.5) in calcaneal fractures (p = 0.043). A lower length of stay (p = 0.007), a reduction in pain (p. preop. = 0.05; p. discharge. < 0.001) and need for narcotics (p. preop. = 0.064; p. postop. = 0.072), an increased reduction in swelling (p < 0.001), and a lower revision rate (p = 0.044) could also be seen, and a trend towards fewer complications (p = 0.216) became apparent. Conclusion. Compared with elevation, VIT results in a significant reduction in the time to achieve operability in complex joint fractures of the lower limb. Cite this article: Bone Joint J 2021;103-B(4):746–754

Glenohumeral dislocation is complicated with a greater tuberosity fracture in 16% of cases. Debate regarding the safety of closed reduction in the emergency department exists, with concerns over fracture propagation during the reduction manoeuvre. The study aim was to report the results of closed reduction, identify complications and define outcome for these injuries. 188 consecutive glenohumeral dislocations with a tuberosity fracture were identified from a prospective database from 2014–2017. 182 had an attempted closed reduction under appropriate sedation using standard techniques, five were manipulated in theatre due to contra-indications to sedation. Clinical, radiographic and patient reported outcomes, in the form of the QuickDASH and Oxford Shoulder Score (OSS), were collected. A closed reduction in the emergency department was successful in 162 (86%) patients. Two iatrogenic fractures of the proximal humerus occurred, one in the emergency department and one in theatre, representing a 1% risk. 35 (19%) of patients presented with a nerve lesion due to dislocation. Surgery was performed in 19 (10%) cases for persistent or early displacement (< 2 weeks) of the greater tuberosity fragment. Surgery resulted in QuickDASH and OSS scores comparable to those patients in whom the tuberosity healed spontaneously in an anatomical position (p=0.13). 18 patients developed adhesive capsulitis (10%). Glenohumeral dislocation with greater tuberosity fracture can be safely treated by closed reduction within the emergency department with a low risk of humeral neck fracture. Persistent or early displacement of the tuberosity fragment will occur in 10% of cases and is an indication for surgery

Aims

Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone.

Introduction. An important factor in the internal fixation of pertrochanteric fractures is the ability to maintain postoperative reduction. Excessive postoperative sliding of the lag screw or blade may result in reduction loss. We retrospectively analyzed the relationship between postoperative reduction and sliding. Methodology. From Oct. 2009 to Sept. 2011, we treated pertrochanteric fractures using J-PFNA (Synthes) and InterTAN (Smith & Nephew) in 91 cases and 82 cases, respectively. We used postoperative radiographs to classify its reduction. Fractures were classified for its interfragmentary contact using the calcar femorale as a reference on the A-P plane while using the anterior cortex as a reference on the M-L plane. Results. PFNA cases showed greater postoperative sliding than InterTAN cases. Both demonstrated greater sliding when the proximal fragment was positioned inside the medullary canal on the M-L plane than when positioned outside or anatomically. Conclusion. Although the InterTAN can maintain greater initial stability necessary for early weight-bearing, both implants demonstrate the loss of interfragmentary contact when the proximal fragment is positioned inside the medullary canal on the M-L plane resulting in greater risk of reduction loss. In order to maintain postoperative reduction, either anatomical reduction or reducing the proximal fragment outside the medullary canal is advised; no matter what type of internal fixation implants are used

Open reduction and internal fixation (ORIF) with trans-articular screws or dorsal plating is the standard surgical technique for displaced Lisfranc injuries. This aim of this study is to compare the clinical outcomes of percutaneous reduction and internal fixation (PRIF) of low energy Lisfranc injuries with a matched, control group of patients treated with ORIF. Over a seven-year period (2012–2019), 16 consecutive patients with a low energy Myerson B2-type injury were treated with PRIF. Patient demographics were recorded within a prospectively maintained database at the institution. This study sample was matched for age, sex and mechanism of injury to a control group of 16 patients with similar Myerson B2-type injuries treated with ORIF. Clinical outcome was compared using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Manchester Oxford Foot Questionnaire (MOXFQ). At a mean follow up of 43.0 months (95% CI 35.6 – 50.4), both the AOFAS and MOXFQ scores were significantly higher in the PRIF group compared to the control ORIF group (AOFAS 89.1vs 76.4, p=0.03; MOXFQ 10.0 vs 27.6, p=0.03). There were no immediate postoperative complications in either group. At final follow up, there was no radiological evidence of midfoot osteoarthritis in any patient in the PRIF group. Three patients in the ORIF group developed midfoot osteoarthritis, one of whom required midfoot fusion. PRIF is a technically simple, less invasive method of operative stabilisation of low energy Lisfranc injures which also appears to be associated with better mid-term clinical outcomes compared to ORIF

Introduction. Transscaphoid perilunate dislocation is a rare injury and therefore it is easily missed at the initial treatment. Once ignored, an alternative treatment such as proximal row carpectomy is indicated, but surgical outcome is not as good as that of an early reduction. Also late reduction (> 3 months) is not possible and needs extensive dissection. We present an alternative technique of staged reduction with better outcome. Material & Methods. 16 cases (14 males & 2 females) with neglected Transscaphoid perilunate dislocation (> 3 month old) were treated with staged reduction. In first stage an external fixator was applied across the wrist and distraction was done at 1mm/day. Second surgery was done through dorsal approach and we were able to reduce all the fractures & dislocations. Herbert screws and K wires were used for fixation. Results. The mean duration between two surgeries was 2.4 weeks (range 2–4 weeks). 13 cases had excellent results, one had fair result. Two patients developed reflex sympathetic dystrophy and had poor results. Conclusion. Staged reduction should be considered for neglected Transscaphoid perilunate dislocations. If properly executed, a good functional pain free range of motion is the usual outcome

Magnetic resonance imaging (MRI) validation of a novel method of assessing Distal Radial Fracture (DRF) reduction using the hypothesised constant relationship between the dorsal radial cortex (DC) and the superior pole of the lunate (SL). MRI scans of 28 normal wrists were examined. Scans included the distal third of the radius to the proximal carpal row. Beginning 5cm proximal to the distal radius articular surface, a line was superimposed upon the DC extending distally through the metaphyseal flare. Lunate height (LH) and distance from the DC line to the SL (DC-SL) were measured at 5-degree rotational increments around the radial shaft central axis to a total of 30 degrees of supination and pronation (S+P). The DC-SL/LH ratio was compared to 0 degrees (anatomical lateral) using the two-tailed paired student t-test. There was no significant difference in DC-SL:LH between 0 degrees of rotation and any 5-degree increment up to 30 degrees of S+P (lowest p=0.075). The DC line lay consistently dorsal to the SL. A constant DC-SL relationship exists with up to 30 degrees of S+P. This reference can be quickly and accurately used to assess DRF reduction in poorly-taken films with malrotation up to 30 degrees from anatomical lateral. Research comparing DC-SL distance with volar tilt to assess DRF reduction is needed

INTRODUCTION. Studies have suggested that there is a reduction in head-neck-ratio (HNR) associated with MoMHRA. A reduction in HNR at operation would decrease range of movement and increase impingement risk. Impingement could lead to 20 edge loading, increasing wear. Serum ion levels of Chromium (Cr) and Cobalt (Co) are surrogate markers of wear. Although acetabular component orientation has been shown to contribute to wear and PT development, the role of a decrease in HNR has only been highlighted in PT development. This study aimed to measure changes in HNR that occur at resurfacing and determine any gender- and component size-specific differences. In addition it aimed to determine whether changes in HNR could be associated with increased wear. METHODS. 84 patients (56M: 28F) with unilateral MoMHRA were included. The mean age at surgery was 57 years. The mean femoral component was 49mm. Components were considered small if <45mm, average if between 45–50mm and large if >50mm. Three designs were implanted; BHR, C+ and Recap. The average follow up was 4 years. All patients had Cr/Co levels measured at follow up. Patients were considered to have high ions if Cr and Co levels were 5.1ppb and 4.4ppb respectively. Pre-operative HNR (HNRpre) and the post-operative HNR (HNRpost) were made from the respective pelvic radiographs. Assuming a 2mm thick cartilage layer, the HNR based on the diameter of the articular cartilage pre-operatively (HNRart) was calculated. The immediate changes in HNR as a result of the operation were expressed relative to articular HNR pre-op:. HNRartpost=HNRpost–HNRart. RESULTS. The changes in HNR at operation were significantly negatively correlated with HNRpre, (p<0.001), (rho=−0.77). Females had greater ion levels (p=0.013) and smaller components (p<0.001). Females had bigger pre-operative HNRart and were downsized more (p<0.001). Similarly, patients with small components had higher ions (p=0.032). They had greater HNRart and were downsized more (p<0.001) Twelve patients comprised the high ion group. These patients had smaller components (p=0.004), greater HNRart and were down-sized significantly more at resurfacing (p<0.001). DISCUSSION. This study highlights HNR changes that occur in resurfaced hips. Females, patients with small components and patients in the high ion group had higher pre-operative HNR and were downsized more at operation. Femoral downsize, would probably increase impingement risk, lead to secondary edge loading and contribute to greater incidence of wear related problems

Twenty-three patients with thirty hips of slipped capital femoral epiphysis were treated in our department, KK Women's and Children's Hospital, Singapore between 1997 and 2005. Except one patient lost of follow-up, twenty-four SCFEs with more than 2 years (25 to 73 months, average 38.5 months) follow-up were reviewed. This study is to evaluate the effectiveness and outcome of our protocol: Russell traction followed by gentle manipulative reduction with a single screw fixation & spica cast immobilization (for acute-on-chronic cases with unstable and reducible SCFE). In this series, there were 13 boys & 5 girls, mean age 12 year old ranging from 10 to 14 years. Among them 7 were Chinese, 6 Malays & 5 Indians. There were 12 unilateral cases (8 on the left & 4 right, 67%) & 6 bilateral cases (33%), including 2 patients found contralateral SCFE subsequently 1 year postoperatively. Acute-on-chronic SCFE were 16 & chronic SCFE 8. 16 were Grate I & 8 Grate II. Russell traction was on preoperatively with an average of 6 days. Gentle manipulative reduction under general anesthesia was performed in 20 SCFEs (12 GI & 8 GII) and 17 of them were successful. Fixation with a single screw was used for all cases except one hip with 2 screws. Average follow-up was 38.5 months. Good results achieved. All patient were symptom free with good function. No complications of AVN, chondrolysis, screw loosening and reslipping of the affective hips. Our protocol of management for SCFE has been largely successful in term of manipulative reduction and fixation

We reviewed 110 patients with an unstable fracture of the pelvic ring who had been treated with a trapezoidal external fixator after a mean follow-up of 4.1 years. There were eight open-book (type B1, B3-1) injuries, 62 lateral compression (type B2, B3-2) and 40 rotationally and vertically unstable (type C1-C3) injuries. The rate of complications was high with loss of reduction in 57%, malunion in 58%, nonunion in 5%, infection at the pin site in 24%, loosening of the pins in 2%, injury to the lateral femoral cutaneous nerve in 2%, and pressure sores in 3%. The external fixator failed to give and maintain a proper reduction in six of the eight open-book injuries, in 20 of the 62 lateral compression injuries, and in 38 of the 40 type-C injuries. Poor functional results were usually associated with failure of reduction and an unsatisfactory radiological appearance. In type-C injuries more than 10 mm of residual vertical displacement of the injury to the posterior pelvic ring was significantly related to poor outcome. In 14 patients in this unsatisfactory group poor functional results were also affected by associated nerve injuries. In lateral compression injuries the degree of displacement of fractures of the pubic rami caused by internal rotation of the hemipelvis was an important prognostic factor. External fixation may be useful in the acute phase of resuscitation but it is of limited value in the definitive treatment of an unstable type-C injury and in type-B open-book injuries. It is usually unnecessary in minimally displaced lateral compression injuries

Materials and method. This study included 309 patients, over the age of 60 (44 men, 256 women, mean age 85.6 years) who underwent osteosynthesis using a short femoral nail(Gamma)for femoral intertrochanteric fractures. The new reduction classification was defined, in AP view by the degree of contact between the medial cortex of the proximal fragment and that of the medial cortex of the distal fragment. The classification in AP view is divided into three Types: Anatomical Type, Medial Type, and Lateral Type. As for the ML view was defined based on the degree of anterior cortex contact between proximal and distal fragment, was divided also into Anatomical Type, Intramedullary Type, and Extramedullary Type. We assessed lag screw sliding amount at 2 weeks period after surgery as the post-operative displacement. Results. The sliding at 2 weeks was in AP Anatomical Type 3.7mm, in Medial Type 3.2mm and in Lateral Type 9.4mm. The sliding in the Lateral Type was much greater than those of Anatomical Type and Medial Type (Significant p-value, p=0.01, 0.01). Likewise, in the ML view, Anatomical Type 3.0mm, Intramedullary Type 6.2mm and Extramedullary Type 4.7mm respectively. There was a significant difference between ML Anatomical Type and Intramedullary Type(p=0.01). Conclusion. The AP Lateral Type and the ML intramedullary Type were the most post-operative displacement. A new reduction classification could be useful to assist in the prediction of post-operation displacement

Introduction. Large wear rate reductions have been shown for crosslinked PE in simulators and short- to mid-term clinical wear studies. However, concerns persist about long-term in-vivo oxidation (especially with annealed PE), late accelerating wear and the possibly higher osteolytic potential of crosslinked PE particle debris. This is the first long-term study comparing conventional to crosslinked PE investigating whether the wear reduction is maintained in the long-term and if reduced osteolysis becomes evident. Materials & Methods. In a prospective study 48 primary THA patients (Stryker ABG-II, 28mm CoCr heads) were randomized to either receive a first generation crosslinked PE (Stryker Duration: 3MRad gamma irradiation in N2, annealed) or then conventional, now “historic” PE (3MRad gamma irradiation in air). Both groups were statistically non-different (p>0.1) regarding age (63.9 years), gender, BMI, stem and cup size, cup inclination, liner thickness or pre- and post-op HHS leaving the insert material as the only variable. Patients were followed-up annually using the Harris Hip score, AP and lateral radiographs and digital wear measurements using Roman V1.70 [1, 2]. Wear and radiographic signs of osteolysis were analysed at a mean follow-up of 12.9 years (12.0–13.3). Groups were compared using the t-test (means) or the Fisher Exact test (proportions). Results. Thirty-one patients (18 conventional, 13 Duration) were left for analysis (8 deaths, 9 lost to FU). At 13yrs the total linear head penetration was sign. lower with Duration (0.70 ±0.36mm, range: 0.3–1.2mm) than conventional PE (1.56 ±0.83, range: 0.4–3.3mm, p=0.015). Also the annual wear rate was sign. lower (p=0.005) for Duration (0.063 ±0.027mm/yr) than conventional PE (0.122 ±0.065mm/yr). This reduction (−48%) compared well to the original simulator prediction (−45%) and even increased with time (−30% at 5yrs, −38% at 8yrs, −42% at 10yrs). In the Duration group only 1 patient had a wear rate >0.1mm/yr (osteolysis threshold) compared to 10 in the Conventional group (p=0.007). Patients with radiographic signs of acetabular osteolysis (cysts) on the AP x-ray were less frequent in the Duration (4/13=31%) than in conventional group (13/18=72%, p=0.023). This difference became even more pronounced when also the lateral view was evaluated and the affected DeLee-Charnley zones were counted (7 vs 22, p=0.017). Only in the conventional group a revision was performed (cup for wear). Discussion & Conclusions. At long-term FU the absolute wear rate of Duration crosslinked PE did not increase but decrease and the wear relative reduction did not deteriorate but increased. The incidence of osteolysis was sign. less. Thus No clinical evidence of degradation or elevated osteolytic potential for this annealed first generation crosslinked PE debris was found

A total of 179 adult patients with displaced intra-articular fractures of the distal radius was randomised to receive indirect percutaneous reduction and external fixation (n = 88) or open reduction and internal fixation (n = 91). Patients were followed up for two years. During the first year the upper limb musculoskeletal function assessment score, the SF-36 bodily pain sub-scale score, the overall Jebsen score, pinch strength and grip strength improved significantly in all patients. There was no statistically significant difference in the radiological restoration of anatomical features or the range of movement between the groups. During the period of two years, patients who underwent indirect reduction and percutaneous fixation had a more rapid return of function and a better functional outcome than those who underwent open reduction and internal fixation, provided that the intra-articular step and gap deformity were minimised

Background

Chronic acquired radial head dislocations pose a complex problem in terms of surgical decision making, especially if surgery has already previously failed. There are several underlying causes that should be investigated, including previous trauma resulting in a missed Monteggia fracture.

Rivaroxiban is a factor Xa inhibitor and is a newer oral alternative for thromboprophylaxis after joint replacements. Its major advantage is its oral administration and hence better patient compliance. However there are some doubts about its efficacy compared to dalteparin/heparin. We have recently changed over from using dalteparin injections to rivaroxiban tablets for thromboprophylaxis after hip replacements. We assessed our results to find efficacy and specificity of its action in patients undergoing THR. 504 patients underwent hip replacement in last 2 years. 316 were treated with dalteparin injections (fragmin) for thromboprophylaxis while 189 patients were treated with oral rivaroxiban for 35 days after their hip replacement. Average haemoglobin drop at 24 hours postop was 2.79 in Rivaroxiban group compared to 3. 10 in dalteparin group. 19 patients (of 189 i.e. 10.05%) required postop blood transfusion in rivaroxiban group as against 60 (of 315 i.e. 19.04%) in Dalteparin group. This difference was statistically significant. Incidence of DVT was no different in either groups, but the number of patients was too small to compare this. Rivaroxiban appears to be more specific in its action and our results suggest a significant reduction in postop blood transfusion following hip replacements without any increase in rate of Deep Vein Thrombosis. We would like to present our findings and discuss role of oral thromboprophylaxis after joint replacements

Recent findings about UHMWPE oxidation from in vivo stresses lead to the need of a better understanding of which anti-oxidant additivation method is the best option for the use in orthopaedic field. A GUR 1050 crosslinked Vitamin E - blended UHMWPE has been investigated, to provide an accurate outline of its properties.

DSC and FTIR measurements, together with ageing and tensile tests were performed on compression moulded blocks, as well as biocompatibility tests, including implantation on rabbits. Moreover, wear simulations on finished components (Delta acetabular liners) have been completed.

All the test procedures have been repeated for a reference material, a GUR 1050 crosslinked and remelted standard UHMWPE (commercial name UHMWPE X-Lima), and the outcomes have been compared to the crosslinked Vitamin E - blended UHMWPE ones.

On the additivated UHMWPE, we found a ultimate tensile strength of 43 MPa, a yield strength value of 25 MPa, and an elongation to breakage equal to 320%. The degree of cristallinity was 45 ± 2%, and no signal of creation of oxidation products was detected up to 2000 h of permanence in oxidant ambient after the ageing test. The reference material showed comparable mechanical resistance values (∗ = 40 MPa, y = 20 MPa, 350% elongation), a cristallinity of 46 ± 2%, and the creation of oxidation products starting from 700 h in oxidant ambient. The biocompatibility tests indicate that the additivated material is biocompatible, as the reference X-Lima UHMWPE.

Wear tests gave a wear rate of 5,09 mg/million cycles against 6,13 mg/million cycles of the reference material, and no sign of run in wear rate.

Our results indicate that there is no change in mechanical properties in respect to the reference material. This is confirmed by DSC measurements, that show no change in cristallinity. The blend between polymer and additive assures an uniform concentration of Vitamin E across the whole thickness of the moulded block, and ageing test results on additivated UHMWPE have shown that the material possess a superior resistance to degradation phenomena.

Biocompatibility assess that the presence of Vitamin E is not detrimental for the in vivo use of the material, and wear results indicate a better wear resistance of the material, especially in the first stages of the wear process.

From these considerations, it can be concluded that the material, in respect to the standard UHMWPE, is highly resistant to oxidation phenomena, therefore it is expected to have superior in vivo endurance performance.

Aims. Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods. A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results. A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). Conclusion. The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort. Cite this article: Bone Jt Open 2024;5(1):46–52

Aims. Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. Methods. We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d’Aubigné score and Matta’s radiological grading at one year and at latest follow-up. Results. Immediate postoperative radiological Matta’s reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d’Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta’s radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d’Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta’s radiological grading at latest follow-up also remained unchanged. Conclusion. Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window. Cite this article: Bone Jt Open 2024;5(2):147–153