H-Shaped Anatomical Titanium Plate: Biomechanical Validation and Clinical Application in the Treatment of Complex Posterior Wall/Column Acetabular Fractures

Abstract

Objective: Approximately 80% of acetabular fractures involve the posterior wall and posterior column, which are complex and challenging to treat. The H-shaped anatomical titanium plate (HTP) facilitates anatomical reduction, minimizes complications, and enhances safety, efficacy, and speed. This study aims to conduct biomechanical testing and clinical evaluation of HTP to assess its stability and efficacy in treating these fractures.

Methods: In the biomechanical research, posterior column with posterior wall fractures was created on nine acetabular models procured from Sawbones, USA and were allocated to three fixation groups: (1) a single reconstruction plate combined with a single cortical screw (PCS), (2) double parallel reconstruction plates (2P), (3) HTP. Following anatomic reduction, cyclic loading and destructive experiments were conducted to assess the efficacy of different fixation devices under various loads for the posterior wall and column, as well as their peak load and structural stiffness. Additionally, we retrospectively analyzed the clinical data of 53 patients (46 males, 7 females; mean follow-up 24.6 ± 3.2 months) with the HTP at our hospital from April 2017 to January 2023. Clinical outcomes mainly included changes in postoperative pain, reduction quality (Matta criteria), hip function (Merle d'Aubigné Postel/Harris scores), and the incidence of complications.

Results: Biomechanical results showed that in cyclic loading tests, the relative displacement of the posterior wall and the posterior column fixed with the HTP was smallest, with statistically significant differences (p < 0.05). In the destructive experiment, compared to the 2P group (2062.89 ± 375.45 N, 412.16 ± 25.87 N/mm) and the PCS group (1477.89 ± 161.57 N, 204.21 ± 34.94 N/mm), the HTP group (3342.67 ± 354.15 N, 652.52 ± 24.25 N/mm) demonstrated superior peak load and structural stiffness, with statistically significant differences (p < 0.05). Clinically, Postoperative Visual Analogue Scale scores significantly decreased, indicating effective pain management. 84.91% achieved anatomic reduction, with 92.45% and 90.56% good/excellent functional outcomes (Merle d'Aubigné Postel and Harris scores, respectively). The incidence of various complications was low, with no cases of implant failure observed.

Conclusions: The HTP demonstrates robust stability in biomechanical experiments, offering distinct advantages for clinical applications and widespread adoption. In the treatment of the posterior column/posterior wall fractures, the integrated fixation of HTP aligns with the physiological anatomy of the acetabulum and has the advantages of simple operation, short operation time, strong stability, minimal risk of vascular and nerve injury, and fewer complications.

Keywords

acetabular fractures / biomechanics / H-shaped anatomical titanium plate / posterior column fracture / posterior wall fracture

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