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The investigators conducted such a prospective randomized controlled study aiming to reach a satisfactory outcome and to compare supra-pectineal QL buttress plating versus infra-pectineal for management of anterior column with or without posterior hemi-transverse component and quadrilateral plate involvement.
Our hypothesis was that supra-pectineal quadrilateral buttress plating provides much more rigid fixation and a strong buttress for medial wall migration, also it could correlate with a better functional and radiological outcome. However, there is a lack of knowledge in the prospective assessment of functional and radiological outcomes and follow up of postoperative complications of supra-pectineal quadrilateral buttress plating versus infra-pectineal plating in fixation of QLS and to our knowledge, it will be the first study to include such measures of outcome together in a prospective randomized fashion.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| supra-pectineal quadrilateral buttress plating | Active Comparator | Patients treated by supra-pectineal quadrilateral buttress plating through anterior intrapelvic approach |
|
| Infrapectineal plating | Active Comparator | Patients treated by infra-pectineal conventional plating applied on the medial wall through anterior intrapelvic approach |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| suprapectineal quadrilateral buttress plating | Procedure | 15 cases will undergo anatomical supra-pectineal quadrilateral plate |
|
| Measure | Description | Time Frame |
|---|---|---|
| Rate of Excellent, very good, Good, Average or Poor functional outcomes using Modified Merle d'Aubigné scoring system | Clinical assessment was done via Modified Merle d'Aubigné scoring system that was calculated at each follow-up visit (out of 18) and presented the mean value; the score evaluates three factors: pain, mobility & ability to walk. the score maximum being 18 (excellent) and minimum 6 (poor) | one-year post-operative |
| Rate of Anatomical, Congruent or Incongruent Radiological Outcomes using Matta & Tornetta radiological principles | Radiological assesment was done according to the grading of Matta and Tornetta, The investigators classified the results into: Anatomical, congruent & incongruent; based on the restoration of the five anatomical lines (iliopectineal line, ilioischial line, acetabular dome, posterior wall & anterior wall) & best judged on the anteroposterior view. | 1 year postoperative |
| Amount of residual displacement | Residual displacement was measured in millimeters and compared between the two study groups | immediate post-operative and throughout study completion |
| Measure | Description | Time Frame |
|---|---|---|
| post-operative complications' rate | The investigators focused the evaluation of Postoperative complications on the local complications related to fixation principles and technique: LLD, AVN of the hip joint, wound infection, residual malunion or non-union of the quadrilateral plate, and loss of reduction | 1-year post-operative |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Islam S Moussa, MD | no funding recieved | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain Shams university | Cairo | Abassia | 1234 | Egypt |
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An independent doctor created the randomization sequence using Excel 2016 (computerized random numbers) with a 1:1 allocation via random block sizes of 2, 4, and 6; he assigned the sample numbers equally to each group and assigned the block. Patients and physicians allocated to each intervention group were aware of the allocation; however, the data analysts and the outcome assessors were kept blinded to the allocation. The investigators prospectively carried out this study on 30 patients with quadrilateral plate fractures between February 2022 and June 2023 that met our inclusion criteria. The independent doctor allocated the 30 cases to two groups: Group A (15 cases): supra-pectineal quadrilateral buttress plating, group B (15 cases): Infra-pectineal plating
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Double (Investigator, Outcomes Assessor) Patients and physicians allocated to each intervention group were aware of the allocation; however, the data analysts and the outcome assessors were kept blinded to the allocation.
| Infra-pectineal plating | Procedure | 15 cases will undergo conventional manually contoured infra-pectineal plate |
|
| Mean intraoperative blood loss |
The mean blood loss was calculated and compared between the two study groups, it was measured intraoperative and postoperative from suction drains |
| up to 4 days post-operative |
| Mean operative time | The mean operation time was calculated in minutes and compared between the two study groups | it was calculated intra-operative |