The efficacy of posterior plating and anterior column screw fixation in the management of T-shaped acetabular fractures - CART analysis of prospective cohort study.

T-shaped acetabular fractures are challenging injuries. The goal of surgical treatment is to achieve a stable and a concentric reduction of the femoral head under the anatomically reduced weight-bearing dome. There is an ongoing debate about the ideal approach and fixation method for T-shaped fractures. In this study, a group of 34 patients with T-shaped acetabular fractures were treated by posterior plating and anterior column screw. All patients, were followed for at least two years or until hip replacement. The aim of this prospective cohort study was to report the rate of postoperative radiological results together with the early clinical outcome. Anatomical reduction was achieved in 62%, satisfactory reduction of the anterior column with restoration of hip congruency in 82% with excellent to good clinical outcome in 75% of cases. We used classification regression trees (CART) to select the important predictors and generate hypotheses on interaction among them. Residual anterior column displacement >3.5mm was associated with poor clinical results. In cases with residual displacement <3.5mm, the presence of a posterior wall fracture was an independent negative predictor.