Ilioinguinal approach for acetabular fractures

Abstract

Objective

Exposure of the entire anterior column of the acetabulum and of the inner part of the posterior column.

Indications

Open reduction and internal fixation of fractures of the anterior wall and anterior column of the acetabulum and of fractures, which involve both columns, on the condition that the posterior column can be reduced indirectly.

Contraindications

Fractures of the posterior wall.

Fractures of the posterior column.

Fractures which involve both columns where the posterior column has to be reduced directly.

Fractures requiring a direct access to the acetabulum, e.g., with intraarticular fragments.

Surgical Technique

Exposure of the acetabular fracture through three surgical windows. First window situated between the iliopsoas and the iliac crest, second window between the inguinal vessels and the iliopsoas, third window between the spermatic cord and the inguinal vessels. Indirect reduction of the fracture. Orientation through anatomic landmarks and image intensifier. Fixation of fracture with lag screws (iliac crest) and a long curved plate placed on the iliopectineal line.

Results

In a 9-year period, 61 patients with acetabular fractures were treated with a stabilization through an ilioinguinal approach. 27 fractures were classified as “simple” and 34 as “combined”. Intraoperative complications related to the approach were four (6.6%) secondary motoric neurologic damages, one thrombosis of the external iliac artery, and a thrombosis of the iliac veins. One fourth of the patients had paresthesias in the area of the lateral femoral cutaneous nerve. Of 48 patients examined after an average of 23 months, 85.4% obtained an excellent or good result using Merle d’Aubigné and Postel score.