Single Modified Ilioinguinal Approach for the Treatment of Acetabular Fractures Involving Both Columns.

Abstract

To report the technical aspects, radiographic results, and complications of a modified ilioinguinal approach for the treatment of bicolumnar acetabular fractures, especially involving the quadrilateral plate. Retrospective review. Level I Trauma Center, Wuhan Union Hospital, China. Data from all acetabular fractures (n = 96) treated surgically were collected between January 2012 and June 2015. According to the exclusion criteria, 22 patients who had undergone a single supra-ilioinguinal approach with a minimum of 1-year follow-up were included in the study. The supra-ilioinguinal approach was used to treat bicolumnar acetabular fractures by modifying the ilioinguinal approach, using the navel, anterior superior iliac spine, and the symphysis pubis as landmarks. The surgical exposure and reduction of fractures is expected to become more direct and convenient, with shorter surgical time, less blood loss, and fewer complications. Of the 22 consecutive patients, 5 were anterior column with posterior hemi-transverse, 11 were associated both column, 3 were transverse and 3 were T-type patterns. Average length of incision, operative time, and intraoperative blood loss were 10.7 ± 1.1 cm, 182 ± 40 minutes, and 793 ± 228 mL, respectively. Seventeen cases of the reductions were graded excellent; 4, good; and 1, poor. In the last follow-up, the Merle d 'Aubigné scores showed that 14 cases were excellent; 6, good; and 2, poor. Postoperative deep vein thrombosis occurred in 1 patient and lateral femoral cutaneous nerve injury in 3 patients. For the treatment of bicolumnar acetabular fractures, the supra-ilioinguinal approach provides direct visualization and convenient access to the quadrilateral plate, and allows for appropriate reduction and fixation with few complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.