Quadrilateral plate fractures of the acetabulum: Classification, approach, implant therapy and related research progress

Table 1 Comparison of several classic anterior approaches for quadrilateral plate fractures

Name	Advantage	Limitation
Ilioinguinal approach	The surgical field is wide, and the upper part of QP can be effectively exposed through the middle window of the ilioinguinal approach, while the distal part can be touched by the fingers. It is especially suitable for acetabular fractures mainly in the anterior column and not involving the posterior wall	QP fractures cannot be directly seen, but can only be touched. Better reduction skills and tools are required, and it is prone to incomplete reduction. There are long incisions, large trauma, and complicated operations
Modified ilioinguinal approach	Femoral blood vessels are not exposed, and it is less likely to damage femoral blood vessels and nerves. There is relatively small blood loss	The same as above
Modified Stoppa approach	QP fractures can be fully seen and sufficiently exposed, so that direct reduction and fixation of QP fractures can be achieved effectively. It is especially suitable for QP fractures accompanied by medial displacement of the femoral head	This approach is limited in the case of acetabular fractures involving the high iliac ala or posterior column. It cannot sufficiently expose the anterior acetabulum, and cannot be used for posterior wall fracture. It is difficult to correct the rotation displacement of the posterior column acetabular fracture. It is often needed to be combined with iliac fossa approach in anterior column reduction. The screw direction is limited at the approach
Pararectus approach	Acetabular fractures can be handled under direct vision, and it is convenient to conduct reduction and fixation of acetabular fractures involving QP. It is closer to the fracture site than other approaches, and it is ideal for obese patients	It cannot well expose the fractures complicated with high suprapubic branch, iliac ala or anterior wall acetabular fractures, and the oblique incision at the iliac crest is often needed for reduction and fixation. It may cause denervation of the rectus abdominis, damaging the peritoneum. Retrograde ejaculation and erectile dysfunction may be left in male patients

QP: Quadrilateral plate.

Table 2 Our recommendations for the treatment of quadrilateral plate fractures based on the Yang et al[14] classification hypothesis

	Ilioinguinal approach	Modified stoppa approach	Pararectus approach
Type A			Recommended
Type B	Recommended
Type C		Recommended (sometimes an iliac fossa approach can be combined)

We divided the line from the ischial spine to the iliopubic eminence in the QP into two parts (refer to Figure 1D). Type A: The fracture line involving the posterior half of the QP (refer to Figure 1D); Type B: The fracture line involving the anterior half of the QP(refer to Figure 1D); Type C: The fracture lines involving both the posterior and anterior half of the QP (refer to Figure 1D); QP: Quadrilateral plate.