Correlation of functional and radiological outcome after surgical treatment of acetabular fractures with quadrilateral plate involvement. A meta-analysis.

Abstract

Quadrilateral plate fractures are complex injuries often requiring surgical management. Nevertheless, postoperative reduction quality has not been consistently correlated with functional outcome. We conducted a meta-analysis evaluating the association between functional and radiological outcomes of patients with acetabular fracture involving the quadrilateral plate who were treated surgically with open reduction and internal fixation. A comprehensive search of PubMed, Cochrane Library and Web of Science databases was performed to identify prospective and retrospective studies reporting the functional and radiological outcomes after internal fixation of acetabular fractures with quadrilateral plate involvement. Literature screening was based on eligibility criteria, extracted relevant data and on the quality of included studies. Meta-analysis evaluated functional (Harris Hip Score (HHS) and the Merle d'Aubigné and Postel (MAP)) outcomes as well as radiological (MATTA) outcomes, pooling agreement proportions, assessing heterogeneity, and performing meta-regression using R. We included 12 studies with 336 patients treated for acetabular fracture involving the quadrilateral plate. Seven studies (177 patients) reported MAP scores: excellent 41%, good 47%, poor 12%. Seven studies (217 patients) reported HHS scores: excellent 47%, good 31%, poor 22%. Overall, MATTA scores in 336 patients were excellent 66%, good 27%, poor 7%. Agreement between MAP and MATTA was 51% overall (95% CI 29-71%, I2=85%), 53% excellent vs good, 95% excellent vs poor, and 71% good vs poor. Agreement between HHS and MATTA was 58% overall (95% CI 46-71%, I2=43%), 65% excellent vs good, 70% good vs poor, and 90% excellent vs poor. Meta-regression found no significant predictors. Association was observed between postoperative radiological outcomes and functional outcomes (MAP, HHS) in acetabular fractures involving the quadrilateral plate, particularly when scoring was excellent versus poor, underscoring the importance of anatomic reduction as a primary management goal. However, the moderate associations identified suggest that anatomic reduction alone may not determine treatment success, highlighting the role of rigid fixation. The lack of strong correlation between MAP and MATTA scores raises concerns about the adequacy of commonly used functional assessment tools. Further research is warranted to refine evaluation methods and identify predictors of long-term functional recovery in acetabular fracture management.