Clinical outcomes of anterior column fractures treated with percutaneous screws using the modified bent wire technique

ABSTRACT Clinical Outcomes of Anterior Column Fractures Treated with Percutaneous Screws Using the Modified Bent Wire Technique Objective: Acetabular fractures are among the complex and difficult-to-treat fractures of the pelvic ring. Anterior column fractures usually occur after high-energy trauma, and in recent years, minimally invasive techniques have come to the fore as an alternative to the traditional open surgical plate and screw fixation method in order to preserve soft tissue integrity and enable early mobilisation. In this study, we aimed to evaluate the clinical and radiological outcomes in cases where percutaneous screws were applied using the modified bent-tip wire technique for acetabular anterior column fractures. Materials and Methods: Patients diagnosed with acetabulum/pelvis injuries and treated at the Department of Orthopaedics and Traumatology, Faculty of Medicine, Inönü University between 2021 and 2024 were screened; among these, patients with anterior column fractures of the acetabulum treated with percutaneous screw technique were included in the study. The patients' gender, age, occupation, comorbidities, body mass indices, injury mechanisms, additional orthopaedic injuries, additional injuries to other systems, time to surgery, hospital stay, time to full weight-bearing, complications, surgical fixation method, and fracture classifications were recorded. The patients' current and previously obtained radiological examinations were evaluated, and the fracture healing time, degree of reduction after surgery, and radiological evaluations according to the Matta evaluation scale were recorded. Functional evaluations of the patients were performed using modified Merle d'Aubigne and Postel criteria, the Majeed pelvic score, and the Harris hip function score. Additionally, the Visual Analogue Scale (VAS) score was used to assess pain levels. Results: The study included 24 fractures in 21 patients. Eleven patients were female and 10 were male, with a mean age of 45.3 (range = 18–71 years). The mean follow-up period was 105.9 weeks (25–180 weeks). Six patients had additional diseases. Fractures were equally distributed between the right and left hips (12 each). The most common cause of fractures was falls from height (42.9%), while other causes included traffic accidents and being trapped under debris. All patients had extra-acetabular pelvic injuries, and 14 patients (66.7%) also had lower extremity fractures. In addition, 9 patients had trauma to the upper extremities, thorax, vertebrae, and other areas. According to the Judet-Letournel classification, 75% of the fractures were anterior column, 25% were anterior column + posterior hemitransverse; according to the Nakatani classification, 66.7% were Type 2, and 33.3% were Type 3. The average time between trauma and surgery was 3.9 days, and the average hospital stay was 26.6 days. Three patients had bilateral fractures, all of which were treated with percutaneous techniques. In the first surgical attempt, the antegrade method was used in 23 fractures and the retrograde method in 1 fracture. When reduction quality was evaluated according to Matta criteria, 20 fractures (83.3%) were anatomically reduced and 4 fractures (16.7%) were successfully reduced. The average fracture healing time was 12.08 weeks (7–24 weeks), and the average time to full weight-bearing was 12.6 weeks. According to Matta's radiological criteria, 20 fractures (83.3%) were excellent and good, and according to the Modified Merle D'Aubigne-Postel score, 20 fractures (83.3%) were excellent and good. The average Majeed score was 92.3 (75–100), the average Harris Hip Score was 91.83 (76–100), and the average VAS pain score was 1.63 (0–5). Complications developed in a total of 4 patients (19%). These included 2 cases of post-traumatic arthritis, 1 case of pulmonary embolism, and 1 case of screw cut-out. In the two patients who developed arthritis, the cause of arthritis was found to be femoral neck and femoral head fractures, respectively. In the patient who developed pulmonary embolism, it was thought that the complication may have been caused by prolonged exposure to debris. In one case, revision was required due to screw cut-out, resulting in a final treatment of 22 fractures with the antegrade method and 2 fractures with the retrograde method. No neurovascular injuries were observed in any of the patients. Conclusion: This study demonstrates that percutaneous screw fixation using a modified curved guide wire in the treatment of anterior column acetabular fractures is a safe, effective, minimally invasive method with a low complication rate and satisfactory functional results, contributing to the existing literature and supporting the preference for this technique in surgical applications. Keywords: Acetabulum, anterior column fracture, superior pubic ramus fracture, percutaneous fixation