Anterior Approach for the Acetabular Fractures

Article information

J Musculoskelet Trauma. 2019;32(3):157-164

Publication date (electronic) : 2019 January 10

doi : https://doi.org/10.12671/jkfs.2019.32.3.157

Jae Youn Yoon, M.D., Jae-Woo Cho, M.D., Ji Wan Kim, M.D., Ph.D.

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 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 E-mail: bakpaker@hanmail.net

Received 2019 June 25; Revised 2019 June 25; Accepted 2019 June 25.

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

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.

Table 1.

Comparison of the Anterior Approach

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