Clin Orthop Surg.  2018 Sep;10(3):279-285. 10.4055/cios.2018.10.3.279.

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

• Byun Y
• Cho Y
• Kim K

• KMID: 2418746
• DOI: http://doi.org/10.4055/cios.2018.10.3.279

Abstract

BACKGROUND
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. 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. This study aims to present a novel surgical technique of the less invasive anterior iliac approach and compression osteosynthesis for high anterior column fractures of the acetabulum.
METHODS
In this retrospective case series, 19 patients treated operatively for isolated high anterior column fractures using the less invasive anterior iliac approach and compression osteosynthesis were included. Patient demographics, the cause of injury, associated injuries, time to surgical reconstruction, and operation time were collected from the medical records. The quality of reduction was assessed by postoperative standard radiographic views and computed tomography scans and graded according to Matta's criteria. Clinical and radiographic grades were assessed according to Matta's criteria at the last follow-up.
RESULTS
This less invasive surgical technique was successful for reduction and fixation in all high anterior column fractures and provided sufficient stability to allow immediate mobilization of the patients after surgery. Twelve fractures were combined with the quadrilateral plate fracture and seven fractures did not involve the quadrilateral plate. According to Matta's criteria, anatomical reduction was obtained in 17 patients and imperfect reduction in two patients. Clinical results were excellent in 17 patients and good in two patients. Radiographic results were excellent in 17 patients and good in two patients. Ten patients had neurapraxia of the lateral femoral cutaneous nerve related to the approach, which was resolved completely in seven. One patient had deep vein thrombosis.
CONCLUSIONS
Our less invasive surgical technique of the anterior iliac approach and compression osteosynthesis is a useful addition to the existing techniques in the treatment of high anterior column fractures of the acetabulum. Despite being a limited approach and fixation, this technique provides sufficient exposure for reducing and fixing the fracture and adequate stability to allow immediate mobilization of the patient after surgery.

Keyword

Acetabulum; Anterior column fracture; Less invasive surgery; Anterior iliac approach; Compression osteosynthesis

MeSH Terms

Acetabulum*
Demography
Follow-Up Studies
Humans
Medical Records
Retrospective Studies
Venous Thrombosis

Figure

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  Fig. 1 (A) Intraoperative photograph showing the anterior iliac approach. (B) Intraoperative photograph showing the adequate exposure of the anterior column fracture through the anterior iliac approach.

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  Fig. 2 (A) Standard anteroposterior radiograph of a fracture of the left acetabulum. Computed axial tomography (CAT) scans (B) and three-dimensional computed tomography (CT) scan (C) showing an anterior column fracture not involving the quadrilateral plate. (D) Postoperative anteroposterior radiograph of the anterior column fracture stabilized by compression osteosynthesis using a supra-acetabular lag screw and a narrow limited contact dynamic compression plate. Postoperative CAT scans (E) and sagittal reconstruction of CT scan (F) showing anatomical reduction of the fracture.

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  Fig. 3 (A) Standard anteroposterior radiograph of a fracture of the right acetabulum. Computed axial tomography (CAT) scans (B) and three-dimensional CT scan (C) showing an incomplete anterior column fracture with a displaced quadrilateral plate fracture. (D) Intraoperative photograph showing anatomical reduction of the fracture and fixation with a lag screw and a spring plate. (E) Postoperative anteroposterior radiograph of the anterior column fracture stabilized by compression osteosynthesis using a supra-acetabular lag screw and a spring plate. Postoperative CAT scans (F) and sagittal reconstruction of CT scan (G) showing anatomical reduction of the fracture.

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