Objective:

To compare perioperative outcomes among three internal fixation strategies for complex acetabular fractures and to complement clinical findings with finite element analyses.

Approach:

• Finite Element Modeling: A 3D FE model of a both-column acetabular fracture was constructed to compare fixation methods under simulated conditions.
• Clinical Analysis: Retrospective analysis of patients treated for acetabular fractures from November 2021 to May 2023, grouped by fixation strategy.

Key Findings:

• Combined cannulated screw–plate fixation provided better fracture-line displacement control than screw-only fixation, especially under sitting conditions.
• The 3D-printed guide group had significantly shorter operative time than the plate-only group (−56.15 min, P = 0.048) and the conventional screw plus plate group (−68.46 min, P = 0.031).
• The 3D-printed guide group had lower intraoperative blood loss than the plate-only group (−575.48 mL, P = 0.001) and shorter incision length than the plate-only group (−7.94 cm, P = 0.004).
• Both the 3D-printed guide group and conventional screw plus plate group had lower total hospitalization costs than the plate-only group (−39,944.29 RMB, P = 0.040; −32,527.55 RMB, P = 0.048).
• No significant differences were found in complication risk, 3-month hip function, or hospital length of stay.

Interpretation:

Limitations:

• The study is retrospective and may be subject to selection bias.
• Limited sample size for some groups may affect the generalizability of the findings.

Conclusion:

The study compares three internal fixation strategies for complex acetabular fractures, highlighting the differences in perioperative outcomes.