Fixation of Acetabular Fractures with Quadrilateral Plate Involvement Using Intrapelvic Reduction and Buttress Plate via Modified Stoppa Approach: A Clinico-Radiological and Functional Outcome Evaluation

Abstract

Background: Acetabular fractures involving the quadrilateral plate represent complex injuries that pose significant challenges in achieving anatomical reduction and stable fixation. The modified Stoppa approach provides excellent visualization of the quadrilateral surface while minimizing surgical morbidity compared with traditional extensile approaches.
Aim: To evaluate the clinico-radiological and functional outcomes of acetabular fractures involving the quadrilateral plate treated with intrapelvic reduction and buttress plate fixation through the modified Stoppa approach.
Methods: A prospective observational study was conducted in the Department of Orthopaedics, Patna Medical College Hospital (PMCH), from March 2024 to March 2026. Thirty patients with acetabular fractures involving the quadrilateral plate underwent open reduction and internal fixation using buttress plating through the modified Stoppa approach. Clinical outcomes, radiological reduction quality, fracture union, and functional outcomes using the Harris Hip Score (HHS) were assessed over a minimum follow-up period of 12 months.
Results: The mean age was 43.8 ± 12.4 years, with males constituting 76.7% of cases. Anatomical reduction was achieved in 70.0% of patients, while satisfactory reduction was obtained in 90.0%. Fracture union was observed in 28 patients (93.3%). At final follow-up, excellent-to-good Harris Hip Scores were achieved in 83.3% of patients. Better radiological reduction significantly correlated with superior functional outcomes (p=0.004).
Conclusion: The modified Stoppa approach with quadrilateral buttress plating provides excellent exposure, reliable fixation, high union rates, and favorable functional outcomes in acetabular fractures involving the quadrilateral plate.