Functional and radiological outcomes of unstable acetabular fractures with or without quadrilateral plate involvement

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Background: Acetabular fractures are complex injuries that may result in poor hip function, arthritis, and long-term disability if not accurately reduced and fixed. Quadrilateral plate (QP) involvement increases fracture complexity and is often associated with medial femoral head displacement. Aim was to compare the functional and radiological outcomes of unstable acetabular fractures with and without QP involvement among surgically treated patients at NITOR, Dhaka. Methods: This hospital-based comparative observational study was conducted in the Department of Orthopaedic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh, from January 2024 to January 2026. Thirty patients with surgically treated unstable acetabular fractures were divided into two groups: with QP involvement (n=18) and without QP involvement (n=12). Demographic, clinical, radiological, operative, and follow-up data were analyzed using SPSS version 26.0, with p<0.05 considered significant. Results: Patients with QP involvement had significantly more complex fracture patterns (p=0.012), greater preoperative displacement (8.4±2.7 mm vs 5.9±1.8 mm, p=0.008), and more frequent medial femoral head displacement (72.2% vs 16.7%, p=0.008). Operative duration (176.4±34.5 vs 142.5±28.7 minutes, p=0.008) and blood loss (780.0±210.0 vs 560.0±175.0 ml, p=0.005) were significantly higher. Excellent/good functional outcomes (61.1% vs 83.3%) and radiological outcomes (61.1% vs 83.4%) were lower, while complications were more frequent (38.9% vs 16.7%). Conclusions: QP involvement was associated with greater fracture complexity, increased operative difficulty, and a trend toward poorer outcomes, highlighting the importance of meticulous preoperative planning, stable fixation, and close follow-up.

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