Background: An anatomical supra-pectineal quadrilateral surface buttress plate (Union Plate) has been designed and shown promising mechanical strength in vivo. Robot-aided technique has shown promising results in navigation of infra-acetabular and posterior column screws placement. This study sought to further examine whether the emerging anatomical plate provided advantages over the reconstruction plate in robot-aided complex acetabular fracture surgery.
Methods: A retrospective cohort analysis comparing two internal fixation methods was conducted between September 2023 and January 2025. Specifically, 23 patients with complex acetabular fractures received robot-aided Union Plate fixation (Union Plate group), while another 20 patients underwent robot-aided reconstruction plate fixation (Reconstruction plate group). Intra-operative plate contouring time, robot-aided manipulation time, the number of channel adjustments per periarticular long screws, total operation time, blood loss, periarticular long screw placement quality, fracture reduction quality, hip joint function, and postoperative complications were compared between the two groups.
Results: With identical robotic assistance, the Union Plate group experienced significantly shorter times for robot-aided manipulation (−12 min), intraoperative plate contouring (−9 min), and total operation (−23 min), along with reduced blood loss (−128 mL) and fewer channel adjustments of the periarticular long screws, compared to the reconstruction plate group. Both groups achieved satisfactory periarticular long screws placement, with a 95.7% perfect rate in the Union Plate group and 90.4% in the reconstruction plate group, showing no significant difference. Neither group experienced iatrogenic neurovascular injuries or screw penetration. There were also no significant differences in postoperative complications, fracture reduction quality, or hip joint function between the groups.
Conclusion: In surgery for complex acetabular fractures, the Union Plate showed superior operability and safety compared to traditional reconstruction plates. It required less time for robot manipulation, intraoperative plate contouring, and total operation, while also resulting in reduced blood loss and fewer adjustments of the periarticular long screws.
| [1] |
S. Esmaeili, F. Shaker, A. Ghaseminejad-Raeini, M. Baghchi, S. M. Sajadi, and S. H. Shafiei, “Risk Factors for Acetabular Fracture Treatment Failure: A Systematic Review and Meta-Analysis,” BMC Musculoskeletal Disorders 25, no. 1 (2024): 976.
|
| [2] |
A. Gänsslen, J. Lindahl, M. Staresinic, and D. Krappinger, “Outcomes of Acetabular Fractures,” Archives of Orthopaedic and Trauma Surgery 144, no. 10 (2024): 4641–4654.
|
| [3] |
K. Chen, Y. Ji, Z. Huang, et al., “Single Modified Ilioinguinal Approach for the Treatment of Acetabular Fractures Involving Both Columns,” Journal of Orthopaedic Trauma 32, no. 11 (2018): e428–e434.
|
| [4] |
K. Chen, S. Yao, Y. Yin, et al., “A New Classification for Quadrilateral Plate Fracture of Acetabulum,” Injury 54, no. 7 (2023): 110762.
|
| [5] |
T. Freude, A. Gänsslen, D. Krappinger, and J. Lindahl, “Quadrilateral Plate Fractures,” Archives of Orthopaedic and Trauma Surgery 145, no. 1 (2024): 51.
|
| [6] |
K. Chen, F. Yang, S. Yao, Z. Xiong, T. Sun, and X. Guo, “Biomechanical Comparison of Different Fixation Techniques for Typical Acetabular Fractures in the Elderly: The Role of Special Quadrilateral Surface Buttress Plates,” Journal of Bone and Joint Surgery. American Volume 102, no. 14 (2020): e81.
|
| [7] |
G. Papotto, G. Testa, G. Mobilia, et al., “Use of 3D Printing and Pre-Contouring Plate in the Surgical Planning of Acetabular Fractures: A Systematic Review,” Orthopaedics & Traumatology, Surgery & Research 108, no. 2 (2022): 103111.
|
| [8] |
K. Chen, G. Huang, Y. Wan, et al., “Biomechanical Study of Different Fixation Constructs for Anterior Column and Posterior Hemi-Transverse Acetabular Fractures: A Finite Element Analysis,” Journal of Orthopaedic Surgery and Research 18, no. 1 (2023): 294.
|
| [9] |
G. Huang, K. Chen, Y. Wang, and X. Guo, “Finite Element Analysis of the Union Plate in Treating Elderly Acetabular Fracture Patients,” Journal of Orthopaedic Surgery and Research 17, no. 1 (2022): 56.
|
| [10] |
G. Lv, X. Chen, H. Wu, G. Wu, Y. Huang, and G. Huang, “Finite Element Analysis of the Use of Two New Types of Internal Fixation for Acetabular Fractures,” Journal of Orthopaedic Surgery and Research 18, no. 1 (2023): 841.
|
| [11] |
M. A. Küper, A. Trulson, J. Johannink, et al., “Robotic-Assisted Plate Osteosynthesis of the Anterior Pelvic Ring and Acetabulum: An Anatomical Feasibility Study,” Journal of Robotic Surgery 16, no. 6 (2022): 1401–1407.
|
| [12] |
H. Z. Zhu, D. G. Li, Y. F. Li, W. Y. Xu, and G. Chen, “A Systematic Review and Meta-Analysis Comparing Robotic-Assisted Percutaneous Screw Fixation and Conventional Surgical Techniques for Acetabular Fractures,” Journal of Robotic Surgery 19, no. 1 (2024): 17.
|
| [13] |
X. Qi, X. Zhang, Q. Zhang, et al., “Clinical Efficacy and Biomechanical Analysis of Robotic Internal Fixation With Percutaneous Screws in the Treatment of Both-Column Acetabular Fractures,” Scientific Reports 15, no. 1 (2025): 22908.
|
| [14] |
J. Chen, G. Huang, K. Yu, et al., “Robot-Assisted Frame Screws Placement for the Surgical Management of Complex Acetabular Fractures: A Single-Center Retrospective Study,” BMC Musculoskeletal Disorders 26, no. 1 (2025): 1013.
|
| [15] |
J. E. Lonstein, F. Denis, J. H. Perra, M. R. Pinto, M. D. Smith, and R. B. Winter, “Complications Associated With Pedicle Screws,” Journal of Bone and Joint Surgery. American Volume 81, no. 11 (1999): 1519–1528.
|
| [16] |
J. M. Matta, “Operative Treatment of Acetabular Fractures Through the Ilioinguinal Approach: A 10-Year Perspective,” Journal of Orthopaedic Trauma 20, no. 1 Suppl (2006): S20–S29.
|
| [17] |
J. M. Matta, L. M. Anderson, H. C. Epstein, et al., “Fractures of the Acetabulum. A Retrospective Analysis,” Clinical Orthopaedics and Related Research 205 (1986): 230–240.
|
| [18] |
L. Maini, A. Sharma, S. Jha, A. Sharma, and A. Tiwari, “Three-Dimensional Printing and Patient-Specific Pre-Contoured Plate: Future of Acetabulum Fracture Fixation?,” European Journal of Trauma and Emergency Surgery 44, no. 2 (2018): 215–224.
|
| [19] |
H. Shen, L. Zhu, H. Du, et al., “Research on the Distal Repair Effect of Jiawei Buyang Huanwu Decoction on Sciatic Nerve Injury Through Agrin Signaling Pathway,” Journal of Neurorestoratology 11, no. 2 (2023): 100058.
|
| [20] |
X. Guo, J. Hu, S. Feng, et al., “Clinical Neurorestorative Treatment Guidelines for Neurological Dysfunctions of Sequels From Vertebral and Spinal Cord Lesions (CANR 2023 Version),” Journal of Neurorestoratology 11, no. 3 (2023): 100070.
|
| [21] |
W. Lehmann, J. M. Rueger, J. Nuechtern, L. Grossterlinden, M. Kammal, and M. Hoffmann, “A Novel Electromagnetic Navigation Tool for Acetabular Surgery,” Injury 46 (2015): S71–S74.
|
RIGHTS & PERMISSIONS
2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
(1566KB)
