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HOME > J Musculoskelet Trauma > Volume 32(3); 2019 > Article
Review Article Anterior Approach for the Acetabular Fractures
Jae Youn Yoon, Jae Woo Cho, Ji Wan Kim
Journal of Musculoskeletal Trauma 2019;32(3):157-164.
DOI: https://doi.org/10.12671/jkfs.2019.32.3.157
Published online: July 31, 2019
1Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. bakpaker@hanmail.net
2Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

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Abstract

In the surgical treatment of acetabular fractures, the anterior approach is used widely for anterior column fractures with or without posterior column fractures. This paper reviews the anterior approach for the anatomical reduction and rigid fixation of acetabular fractures: traditional ilioinguinal approach, modified Stoppa approach, and new Pararectal approach.


J Korean Fract Soc. 2019 Jul;32(3):157-164. Korean.
Published online Jul 24, 2019.
https://doi.org/10.12671/jkfs.2019.32.3.157
Copyright © 2019 The Korean Fracture Society. All rights reserved.
Review

Anterior Approach for the Acetabular Fractures

Jae Youn Yoon, M.D., Jae-Woo Cho, M.D.,* and Ji Wan Kim, M.D., Ph.D.
    • Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
    • *Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
  • Correspondence to: Ji Wan Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3530, Fax: +82-2-488-7877, Email: bakpaker@hanmail.net
Received June 25, 2019; Revised June 25, 2019; Accepted June 25, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In the surgical treatment of acetabular fractures, the anterior approach is used widely for anterior column fractures with or without posterior column fractures. This paper reviews the anterior approach for the anatomical reduction and rigid fixation of acetabular fractures: traditional ilioinguinal approach, modified Stoppa approach, and new Pararectal approach.

Keywords
Acetabulum, Acetabular fracture, Approach

Figures

Fig. 1
Ilioinguinal approach. (A) Skin incision from the symphysis pubis to the iliac crest. (B) Incision of the inguinal ligament. (C) Iliopectineal fascia. (D) Exposure of the lateral window (white arrow: lateral femoral cutaneous nerve, black arrow: iliopectineal fascia). (E) Exposure of the ilium and anterior sacroiliac joint through the lateral window. (F) Three windows (1: lateral window, 2: middle window, 3: medial window, m: lacuna musculorum, v: lacuna vasorum, s: spermatic cord).

Fig. 2
Modified Stoppa approach. (A) Skin incision-like Pfannelstiel incision; 10 cm transverse incision 2 cm above the symphysis pubis. (B) Subcutaneous dissection. (C) Incision of the fascia (linea alba) of the rectus abdominis. (D) Deep blunt dissection along the superior pubic ramus. (E) Identification of the obturator nerve. (F) Exposure of the quadrilateral surface.

Fig. 3
Modified Stoppa approach for a bilateral pelvis ring injury and right acetabular fracture. (A) Initial pelvis X-ray showing the right acetabular anterior column fracture with the right sacral alar fracture and left pubic fracture. (B, C) Three-dimensional reconstruction images. (D) Postoperative pelvis anteroposterior.

Fig. 4
Pararectal approach. (A) Skin incision. (B) Exposure of the deep fascia. (C) Incision of the rectus sheath. (D) Exposure of the lateral border of the rectus abdominis and retroperitoneal fat. (E) Schematic diagrams of the approach for the retroperitoneal space. (F) Exposure of the anterior column. (G) Reduction of the anterior and posterior column with a Collinear clamp.

Fig. 5
Number of journals published worldwide related to each anterior pelvic approach in acetabular fractures.

Fig. 6
Illustrated images on the range of surgical exposure, according to the type of anterior pelvic approach. (A) Ilioinguinal approach. (B) Modified Stoppa approach. (C) Pararectal approach.

Tables

Table 1
Comparison of the Anterior Approach

Notes

Financial support:None.

Conflict of interests:None.

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    Anterior Approach for the Acetabular Fractures
    J Korean Fract Soc. 2019;32(3):157-164.   Published online July 31, 2019
    DOI: https://doi.org/10.12671/jkfs.2019.32.3.157
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