From heel to hip: medial buttressing for quadrilateral plate fractures of the acetabulum with a locking calcaneal plate

Background: Complex acetabular fractures involving the quadrilateral plate (QLP) present significant surgical challenges due to poor bone quality, the inherent thinness of the QLP, and the proximity of significant neurovascular structures. While modern anatomical plates exist, their high cost and limited accessibility remain barriers. This study evaluates a novel, cost-effective surgical technique using a locked titanium calcaneus plate combined with a suprapectineal reconstruction plate for medial buttressing. Methods: A total of 60 patients treated for acetabular fractures between 2016 and 2025 were reviewed. Ten patients specifically underwent medial buttressing for QLP fractures. Among these, five patients received a locked titanium calcaneus plate fixed to a suprapectineal reconstruction plate. Clinical and demographic data, fracture classifications (Letournel and Judet), and postoperative reduction quality (measured via CT scans) were analyzed. Reduction was categorized as anatomical (< 2 mm) or non-anatomical (≥ 2 mm). Results: The mean age was 39.5 ± 16.1 years. Posterior wall fractures were the most common elementary pattern (60.6%), while anterior column with posterior hemitransverse fractures predominated the complex group (37%). Postoperative CT scans showed anatomical reduction in 83.3% of the total cohort. The mean follow-up was 11.5 months. The surgical approach was predominantly Kocher-Langenbeck (60%), followed by the modified Stoppa (30%) and ilioinguinal (10%) approaches. Conclusion: Combining a locked titanium calcaneus plate with a suprapectineal reconstruction plate is a viable and effective alternative for stabilizing complex QLP fractures. This technique provides stable medial support using widely available implants, making it a good option in clinical settings where patient-specific or modern anatomical plates are unavailable.