Risk of Injury to the Neurovascular Structures in the Pararectus Approach Used in Acetabular Fractures: A Cadaver Study

Abstract

Objectives: Complex acetabular fractures involving the quadrilateral plate may necessitate infrapectineal buttress plating, which can be performed through the pararectus approach. The aim of this cadaveric study was to identify the anatomical guide points to protect neurovascular structures at the risk of injury during the pararectus approach. Methods: Six fresh frozen cadavers (12 hemipelves) were dissected in this study. Location of the inferior epigastric artery (IEA), obturator nerve and corona mortis (CM) was measured using common anatomic landmarks, namely, anterior superior iliac spine, symphysis pubis (SP), and sacroiliac (SI) joint. Results: In the superficial dissection of the abdominal wall, the mean distance between the IEA and anterior superior iliac spine was 106.7 ± 5.2 (range, 99.2–116.4) mm, and the mean distance between IEA and SP was 77.9 ± 3.5 (range, 70.6–82.2) mm. In deep dissection, the mean distance between the SI joint and the SP was 133.1 ± 5.7 (range, 126.0–142.0) mm. The mean distance between the SI joint and ON was 37.3 ± 2.8 (range, 31.0–41.0) mm. The CM was unable to be detected in 2 cadavers, 1 on the right and 1 on the left hemipelves. The mean distance between the CM and SP was 47.7 ± 3.9 (range, 43.0–55.0) mm. Conclusions: A pararectus approach is a useful approach which allows infrapectineal plating in the treatment of complex acetabular fractures; however, the preservation of critical neurovascular structures is essential during dissection. This study is helpful to identify the structures at risk according to commonly used anatomic landmarks. These data might be a necessary guideline for hip and trauma surgeons.

Corona mortis: clinical evaluation of prevalence, anatomy, and relevance in anterior approaches to the pelvis and acetabulum

“…When encountered in anterior pelvic approaches, it is associated with significant bleeding events [2][3][4][5][6]. Anatomical studies have observed a prevalence ranging from 33% to 83% [8][9][10][11][12][13]. Clinical series report a lower prevalence of 1-52% [3,10,14], and radiographic studies indicate a prevalence of 14-33% (arterial CM) and 29-51% (venous CM) [19][20][21] (Tables 4, 5, and 6).…”

“…Letournel and Judet, among the first to use this nomenclature, questioned its clinical relevance, having encountered just one instance of this variant [7]. While anatomical studies indicate CM vessel prevalence of 33-83% [8][9][10][11][12][13], clinical studies report lower figures between 1-52% [3,10,14]. Only two studies in orthopedic pelvic surgery have addressed this topic, showing a prevalence of 1% and 38%.…”