The Ilioinguinal Approach

Tosounidis, Theodoros H.; Giannoudis, Vasillios P.; Kanakaris, Nikolaos K.; Giannoudis, Peter V.

doi:10.2106/jbjs.st.16.00101

Cited by 27 publications

(28 citation statements)

References 15 publications

(15 reference statements)

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“…Although the ilioinguinal approach is more commonly used, there is a threat of injury to the contents of the inguinal canal and the femoral neurovascular bundles. 13 With the introduction of the modified Stoppa approach, the 'middle window' is avoided, thus curtailing the threat of injury to the above structures. A vast majority of studies reporting good to excellent outcomes via this approach are from developed nations.…”

Section: Discussionmentioning

confidence: 99%

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

Nayak

Mittal

Trikha

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Background: As the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures. Methods: Twenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d'Aubigne and Postel score with a mean follow up of 15.13 months. Results: The clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively. Conclusions: Minimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.

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Section: Discussionmentioning

confidence: 99%

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

Nayak

Mittal

Trikha

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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“…• The modified Stoppa approach facilitates the management of fractures of the anterior column such as the so-called anterior column posterior hemitransverse, very low anterior column, and low anterior column fractures. As an extension to the modified Stoppa approach, the first window of the ilioinguinal approach by a separate incision to the modified Stoppa approach might become necessary for the management of so-called high anterior column fractures as well as in fractures involving the posterior column (T-type, transverse, or associated both-column fracture, with the main dislocation in the anterior column) 7,8 . As an extension of the first window of the ilioinguinal approach, an osteotomy of the anterior superior iliac spine might become necessary for management of anterior wall fractures.…”

Section: Contraindicationsmentioning

confidence: 99%

Open Reduction and Internal Fixation of Acetabular Fractures Using the Modified Stoppa Approach

Tannast

Keel

Siebenrock

et al. 2019

JBJS Essential Surgical Techniques

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Background: The modified Stoppa approach is performed for safe and efficient management of acetabular fractures involving the anterior column. This approach avoids dissection of the inguinal canal, the femoral nerve, and the external iliac vessels as seen in the "second window" of the ilioinguinal approach and has thus been shown to be less invasive than the ilioinguinal approach 1. As an intrapelvic approach, it facilitates the management of medial displacement fracture patterns involving the quadrilateral plate and dome impaction that typically occur in the elderly 2,3. The reduced morbidity of this approach is of particular relevance for elderly patients who must respond to the stresses of injury and surgery with diminished physiological reserves. Description: The specific surgical steps include preoperative planning, patient positioning and setup, a Pfannenstiel incision, superficial and deep dissection, development of the Retzius space and retraction of the bladder, exposure of the superior pubic ramus and iliopectineal eminence, dissection and ligation of a potential corona mortis, exposure of the obturator nerve and vessels, subperiosteal preparation of the pubic ramus with retraction of the external iliac vessels, subperiosteal exposure of the quadrilateral plate with detachment of the internal obturator muscle and exposure of the posterior column, assessment of residual displacement by fluoroscopic views, longitudinal soft-tissue or lateral skeletal traction (optional) for reduction of medial displacement of the femoral head, disimpaction of the acetabular dome fragment and grafting of the supraacetabular void (optional) under fluoroscopic and arthroscopic (optional) control, and reduction and fixation of extra-articular components (iliac wing posteriorly and pubic ramus anteriorly), the posterior column (infraacetabular screw), and the quadrilateral plate (buttress plate). Before wound closure, the urine output is checked for occurrence of hematuria, an indication of bladder penetration. The anterior lamina of the rectus sheath is then sutured, and a layered closure performed. Alternatives: The ilioinguinal approach might be used instead.

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“…And low risk for peritoneal injury [15]. So, nowadays there is resurgence again to the ilioinguinal approach [10].…”

Section: Morphological Findingsmentioning

confidence: 99%

“…Management of acetabular fractures involving the anterior all and column is challenging [9]. Although nowadays there are many surgical approaches invented to access the anterior acetabular wall and column, still the ilioinguinal approach is considered the state of the art approach for the open surgical reduction and internal fixation of the anterior fractures of the acetabulum [10]. In this approach, dissection around the femoral vessels in its middle window constitutes a high risk for their iatrogenic injury that necessitates special caution [11].…”

Section: Morphological Findingsmentioning

confidence: 99%

“…In this approach, dissection around the femoral vessels in its middle window constitutes a high risk for their iatrogenic injury that necessitates special caution [11]. Knowing that these vessels lie directly in a close relation to the anteromedial surface of the iliopectineal membrane and ligament, a detailed study of its morphological anatomy together with carrying out special tacts during surgical dissection can reduce this risk significantly [1,10]. This Ilioinguinal approach was first mentioned by Letournel in 1961 as an extra-pelvic, extraperitoneal, trans-inguinal canal approach [12,13].…”

Section: Morphological Findingsmentioning

confidence: 99%

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Iliopectineal Ligament as an Important Landmark in Ilioinguinal Approach of the Anterior Acetabulum: A Cadaveric Morphologic Study

Khanfour¹,

Khanfour²

2019

IJAR

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Background:The iliopectineal ligament is the most stout anterior part of the iliopectineal membrane. It separates "lacuna musculorum" laterally from "lacuna vasorum" medially. This ligament is an important guide in the safe anterior approach to the acetabulum. Aim of the work:To study the detailed anatomy of the iliopectineal ligament demonstrating its importance as a surgical landmark in the anterior approach to the acetabulum. Material and methods:The material of this work included eight adult formalin preserved cadavers. Dissection of the groin was done for each cadaver in supine position with exposure of the inguinal ligament. The iliopectineal ligament and the three surgical windows in the anterior approach to the acetabulum were revealed.Results: Results described the detailed morphological anatomy of the iliopectineal ligament as regard its thickness, attachments and variations in its thickness. The study also revealed important anatomical measurements in relation to the inguinal ligament. The distance between the anterior superior iliac spine (ASIS) to the pubic tubercle ranged from 6.7 to 10.1 cm with a mean value of 8.31±1.3. The distance between the anterior superior iliac spine (ASIS) to the blending point of the iliopectineal ligament to the inguinal ligament ranged from 1.55 to 1.92 cm with a mean value of 1.78±0.15. Conclusion:The iliopectineal ligament detailed morphology and attachments are crucial when planning to do anterior approach of the acetabulum to decrease incidence of iatrogenic injury to the femoral vessels.

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The Ilioinguinal Approach

Cited by 27 publications

References 15 publications

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

Open Reduction and Internal Fixation of Acetabular Fractures Using the Modified Stoppa Approach

Iliopectineal Ligament as an Important Landmark in Ilioinguinal Approach of the Anterior Acetabulum: A Cadaveric Morphologic Study

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