Biological fixation of pelvic ring and acetabular fractures: a pilot study with anatomical validation

Abstract

Background: The middle window of the ilioinguinal approach described by Letournel requires dissection through important structures (inguinal part). We developed a less invasive anterior approach consisting of a medial window (Pfannenstiel) combined with the lateral window of the ilioinguinal approach. Methods: Initially, anatomical validation on two cadaver specimens proved the feasibility of the assumption. Between 2007 and 2012, 15 patients with acetabular fractures and 35 patients with pelvic ring injuries were consecutively operated on using the modified technique. The patients were prospectively followed clinically and by standard radiographs for at least 1 yr. Results: Fifty patients with a fractured pelvis or acetabulum managed to complete at least 1 yr follow-up. Anatomical reduction was achieved in 21 pelvic fractures (60% of pelvic fractures) and in 10 acetabular fractures (67% of acetabular fractures). Satisfactory reduction was achieved in 14 pelvic fractures (40% of pelvic fractures) and in five acetabular fractures (33% of acetabular fractures). Conclusions: The modified approach allows reduction of the anterior column and pelvic ring fractures without requiring dissection through the inguinal neurovascular structures. Our results demonstrate that safe reduction and stable fixation of selected acetabular and pelvic ring fractures is possible with this approach. Level of Evidence: This is considered a level IV evidence study (case series).