Efficacy Comparison of Open Reduction and Robot‐Aided Infra‐Acetabular and Posterior Column Screws Fixation in Complex Acetabular Fractures Surgery: Union Plate Versus Reconstruction Plate

BACKGROUND: An anatomical supra-pectineal quadrilateral surface buttress plate (Union Plate) has been designed and shown promising mechanical strength in vivo. Robot-aided technique has shown promising results in navigation of infra-acetabular and posterior column screws placement. This study sought to further examine whether the emerging anatomical plate provided advantages over the reconstruction plate in robot-aided complex acetabular fracture surgery. METHODS: A retrospective cohort analysis comparing two internal fixation methods was conducted between September 2023 and January 2025. Specifically, 23 patients with complex acetabular fractures received robot-aided Union Plate fixation (Union Plate group), while another 20 patients underwent robot-aided reconstruction plate fixation (Reconstruction plate group). Intra-operative plate contouring time, robot-aided manipulation time, the number of channel adjustments per periarticular long screws, total operation time, blood loss, periarticular long screw placement quality, fracture reduction quality, hip joint function, and postoperative complications were compared between the two groups. RESULTS: With identical robotic assistance, the Union Plate group experienced significantly shorter times for robot-aided manipulation (-12 min), intraoperative plate contouring (-9 min), and total operation (-23 min), along with reduced blood loss (-128 mL) and fewer channel adjustments of the periarticular long screws, compared to the reconstruction plate group. Both groups achieved satisfactory periarticular long screws placement, with a 95.7% perfect rate in the Union Plate group and 90.4% in the reconstruction plate group, showing no significant difference. Neither group experienced iatrogenic neurovascular injuries or screw penetration. There were also no significant differences in postoperative complications, fracture reduction quality, or hip joint function between the groups. CONCLUSION: In surgery for complex acetabular fractures, the Union Plate showed superior operability and safety compared to traditional reconstruction plates. It required less time for robot manipulation, intraoperative plate contouring, and total operation, while also resulting in reduced blood loss and fewer adjustments of the periarticular long screws.