The surgical treatment of anterior column and anterior wall acetabular fractures

Abstract

Isolated fractures of the anterior column and anterior wall are a relatively rare subgroup of acetabular fractures. We report our experience of 30 consecutive cases treated over ten years. Open reduction and internal fixation through an ilioinguinal approach was performed for most of these cases (76.7%) and percutaneous techniques were used for the remainder. At a mean follow-up of four years (2 to 6), 26 were available for review. The radiological and functional outcomes were good or excellent in 23 of 30 patients (76.7%) and 22 of 26 patients (84.6%) according to Matta's radiological criteria and the modified Merlé d'Aubigné score, respectively.Complications of minor to moderate severity were seen in six of the 30 cases (20%) and none of the patients underwent secondary surgery or replacement of the hip.

Less Invasive Anterior Iliac Approach and Compression Osteosynthesis for the Treatment of High Anterior Column Fractures of the Acetabulum

“…Since Letournel 10) introduced the ilioinguinal approach in the 1960s, it has been adopted by many surgeons as the principal anterior surgical approach for the treatment of acetabular fractures for several decades. 3 5 10 11) The classic ilioinguinal approach provides excellent access to the anterior and internal aspects of the entire pelvis and acetabulum. However, most of the complications are related to the neurovascular bundle and lymphatic structures and arise in the intermediate part of the ilioinguinal approach.…”

“…However, the quality of reduction and clinical results in our series are comparable to those of other studies. 5 17 18) …”

“… 1 2 3) Although conservative treatment has shown good results for anterior column fractures with adequate reduction of the femoral head beneath the weight-bearing dome, 4) in recent years, displaced anterior column fractures have increasingly been treated surgically by the ilioinguinal approach and fixation with lag screws and a buttress plate on the pelvic brim. 5) However, a major disadvantage of the ilioinguinal approach is possible damage to the neurovascular bundle and the lymphatic structures in the intermediate part of the approach. To prevent these complications, the modified Stoppa approach, alone or in combination with the lateral window of the ilioinguinal approach, has been advocated for use.…”

Percutaneous fixation of acetabular fractures

“… 3 Open reduction and internal fixation (ORIF) of fractures, associated with rapid rehabilitation, is considered the ‘benchmark’ for treatment. 4 - 8 Judet et al 2 , 3 , 9 have shown that an anatomical reduction with a gap of 2 mm or less is a predictor of good joint function and reduced risk of post-traumatic osteoarthritis. Therefore, the surgeon should try to obtain reductions with zero displacement or up to 1 mm.…”

Digital anatomical measurements and crucial bending areas of the fixation route along the inferior border of the arcuate line for pelvic and acetabular fractures

“…The plate could be placed from the front of the pubic tubercle, the inner side of pubic branch, the inferior border of arcuate line edge, to the sacroiliac joint. It is a perfect fixation route for placing the plate to restore the integrity of the pelvis since it could offer a relative regular and smooth surface with adequate bone thickness [ 10 – 12 ].…”