Skip to main content
SpringerLink
Log in

Dealing with Dome Impaction and Quadrilateral Plate Comminution in Older Patients Treated with Open Reduction and Internal Fixation

  • Chapter
  • First Online:
Acetabular Fractures in Older Patients

  • 388 Accesses

Abstract

Geriatric acetabular fractures tend to occur more frequently in elderly population as a result of low-energy mechanisms than are observed in younger patients, due to an increasing incidence of osteopenia and osteoporosis within this population. In the senior population, acetabular fractures tend to be associated with anterior column disruption, quadrilateral plate involvement, and dome impaction. Superomedial impaction or dome impaction occurs as a result of medialization of the femoral head into the acetabulum and has been associated with poor outcomes in elderly patients. Fractures of the quadrilateral plate result from similar mechanisms and are relatively common among elderly patients who sustain fractures involving the anterior column or wall. This chapter focuses on the operative management of two technically challenging fracture components that occur more frequently in geriatric acetabular fractures: dome impaction and quadrilateral plate comminution.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ferguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010;92(2):250–7.

    CAS  PubMed  Google Scholar 

  2. Laflamme GY, Hebert-Davies J, Rouleau D, Benoit B, Leduc S. Internal fixation of osteopenic acetabular fractures involving the quadrilateral plate. Injury. 2011;42(10):1130–4.

    Article  CAS  PubMed  Google Scholar 

  3. Butterwick D, Papp S, Gofton W, Liew A, Beaulé PE. Acetabular fractures in the elderly: evaluation and management. J Bone Joint Surg Am. 2015;97(9):758–68.

    Article  PubMed  Google Scholar 

  4. Mears DC. Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg. 1999;7(2):128–41.

    Article  CAS  PubMed  Google Scholar 

  5. Archdeacon MT, Kazemi N, Collinge C, Budde B, Schnell S. Treatment of protrusio fractures of the acetabulum in patients 70 years and older. J Orthop Trauma. 2013;27(5):256–61.

    Article  PubMed  Google Scholar 

  6. Henry PDG, Kreder HJ, Jenkinson RJ. The osteoporotic acetabular fracture. Orthop Clin North Am. 2013;44(2):201–15.

    Article  PubMed  Google Scholar 

  7. Hill BW, Switzer JA, Cole PA. Management of high-energy acetabular fractures in the elderly individuals: a current review. Geriatr Orthop Surg Rehabil. 2012;3(3):95–106.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Anglen JO, Burd TA, Hendricks KJ, Harrison P. The “gull sign”: a harbinger of failure for internal fixation of geriatric acetabular fractures. J Orthop Trauma. 2003;17(9):625–34.

    Article  PubMed  Google Scholar 

  9. Moed BR, McMichael JC. Outcomes of posterior wall fractures of the acetabulum. J Bone Joint Surg Am. 2007;89(6):1170–6.

    Article  PubMed  Google Scholar 

  10. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop. 1994;(305):112–23.

    Article  Google Scholar 

  11. Sagi HC, Afsari A, Dziadosz D. The anterior intra-pelvic (modified rives-stoppa) approach for fixation of acetabular fractures. J Orthop Trauma. 2010;24(5):263–70.

    Article  PubMed  Google Scholar 

  12. Guy P. Evolution of the anterior intrapelvic (stoppa) approach for acetabular fracture surgery. J Orthop Trauma. 2015;29(Suppl 2):S1–5.

    Article  PubMed  Google Scholar 

  13. Archdeacon MT, Kazemi N, Guy P, Sagi HC. The modified stoppa approach for acetabular fracture. J Am Acad Orthop Surg. 2011;19(3):170–5.

    Article  PubMed  Google Scholar 

  14. Collinge CA, Lebus GF. Techniques for reduction of the quadrilateral surface and dome impaction when using the anterior intrapelvic (modified stoppa) approach. J Orthop Trauma. 2015;29(Suppl 2):S20–4.

    Article  PubMed  Google Scholar 

  15. Qureshi AA, Archdeacon MT, Jenkins MA, Infante A, DiPasquale T, Bolhofner BR. Infrapectineal plating for acetabular fractures: a technical adjunct to internal fixation. J Orthop Trauma. 2004;18(3):175–8.

    Article  PubMed  Google Scholar 

  16. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632–45.

    Article  CAS  PubMed  Google Scholar 

  17. Casstevens C, Archdeacon MT, d’Heurle A, Finnan R. Intrapelvic reduction and buttress screw stabilization of dome impaction of the acetabulum: a technical trick. J Orthop Trauma. 2014;28(6):e133–7.

    Article  PubMed  Google Scholar 

  18. Cutrera NJ, Pinkas D, Toro JB. Surgical approaches to the acetabulum and modifications in technique. J Am Acad Orthop Surg. 2015;23(10):592–603.

    Article  PubMed  Google Scholar 

  19. Archdeacon MT. Comparison of the ilioinguinal approach and the anterior intrapelvic approaches for open reduction and internal fixation of the acetabulum. J Orthop Trauma. 2015;29(Suppl 2):S6–9.

    Article  PubMed  Google Scholar 

  20. Sen RK, Tripathy SK, Aggarwal S, Goyal T, Mahapatra SK. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach. Injury. 2013;44(2):266–73.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Cincinnati Academic Health Center, Department of Orthopaedic Surgery, Cincinnati, OH, USA

    Brendan R. Southam & Michael T. Archdeacon

Authors
  1. Brendan R. Southam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael T. Archdeacon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brendan R. Southam .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA

    Theodore T. Manson

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Southam, B.R., Archdeacon, M.T. (2020). Dealing with Dome Impaction and Quadrilateral Plate Comminution in Older Patients Treated with Open Reduction and Internal Fixation. In: Manson, T. (eds) Acetabular Fractures in Older Patients. Springer, Cham. https://doi.org/10.1007/978-3-030-25105-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-25105-5_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-25104-8

  • Online ISBN: 978-3-030-25105-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation