This study provides the first biomechanical comparison of the fixation constructs that can be created to treat transverse acetabular fractures when using the “gold-standard” posterior versus the anterior approach with and without a total hip arthroplasty in the elderly. Synthetic hemipelvises partially simulating osteoporosis (n = 24) were osteotomized to create a transverse acetabular fracture and then repaired using plates/screws, lag screws, and total hip arthroplasty acetabular components in one of four ways: posterior approach (n = 6), posterior approach plus a total hip arthroplasty acetabular component (n = 6), anterior approach (n = 6), and anterior approach plus a total hip arthroplasty acetabular component (n = 6). All specimens were biomechanically tested. No differences existed between groups for stiffness (range, 324.6–387.3 N/mm, p = 0.629), clinical failure load at 5 mm of femoral head displacement (range, 1630.1–2203.9 N, p = 0.072), or interfragmentary gapping (range, 0.67–1.33 mm, p = 0.359). Adding a total hip arthroplasty acetabular component increased ultimate mechanical failure load for posterior (2904.4 vs. 3652.3 N, p = 0.005) and anterior (3204.9 vs. 4396.0 N, p = 0.000) approaches. Adding a total hip arthroplasty acetabular component also substantially reduced interfragmentary sliding for posterior (3.08 vs. 0.50 mm, p = 0.002) and anterior (2.17 vs. 0.29 mm, p = 0.024) approaches. Consequently, the anterior approach with a total hip arthroplasty may provide the best biomechanical stability for elderly patients, since this fixation group had the highest mechanical failure load and least interfragmentary sliding, while providing equivalent stiffness, clinical failure load, and gapping compared to other surgical options.

本研究首次对可用于治疗老年髋臼横断骨折的固定结构进行生物力学比较，该结构在老年人中使用“金标准”后入路与前入路有或没有全髋关节置换术。部分模拟骨质疏松症的合成半骨盆 (n = 24) 被截骨以形成横向髋臼骨折，然后使用钢板/螺钉、拉力螺钉和全髋关节置换术髋臼组件以四种方式之一进行修复：后入路 (n = 6)、后入路入路加全髋关节置换术髋臼组件（n = 6）、前入路（n = 6）和前入路加全髋关节置换术髋臼组件（n = 6）。所有标本都经过生物力学测试。各组之间的刚度没有差异（范围，324.6–387.3 N/mm，p = 0.629)、股骨头位移 5 mm 时的临床失效载荷（范围，1630.1–2203.9 N，p = 0.072），或碎片间间隙（范围，0.67–1.33 mm，p = 0.359）。添加全髋关节置换术髋臼组件会增加后路（2904.4 对 3652.3 N，p = 0.005）和前路（3204.9 对 4396.0 N，p = 0.000）入路的最终机械故障负荷。添加全髋关节置换术髋臼组件也显着减少了后入路（3.08 对 0.50 毫米，p = 0.002）和前入路（2.17 对 0.29 毫米，p = 0.024）的骨折块间滑动。因此，前路全髋关节置换术可为老年患者提供最佳的生物力学稳定性，因为该固定组具有最高的机械故障负荷和最少的骨折块间滑动，同时提供等效的刚度，