Introduction We describe an alternative to the Letournel ilioinguinal approach for anterior column acetabular fractures that is performed with a unique retraction device that decreases the rate of soft-tissue complications.
Step 1: Position the Patient and Identify the Sites for the Incisions Identify the sites for both incisions with the help of an image intensifier.
Step 2: Make the First Incision to Expose the Anterior Column and the Linea Terminalis (Pelvic Brim) Make the first incision to expose the central area of the fracture.
Step 3: Make the Second Incision to Expose the Symphysis and the Ipsilateral Pubic Bone Make the second incision to expose the area for the distal plate fixation.
Step 4: Maintain Exposure of the Linea Terminalis Using a Soft-Tissue Retraction System For better visualization, use a soft-tissue retraction system.
Step 5: Reduce the Fracture Clean and reduce the fracture through the first incision.
Step 6: Fix the Fracture Perform temporary and definitive fixation according to the standards for anterior acetabular fracture fixation.
Step 7: Close the Wound After radiographic documentation in three views, close the wound.
Results We reported the results of a case-control study of the first twenty-six patients operated on with the two-incision minimally invasive technique.
Pitfalls & Challenges
We describe an alternative to the Letournel ilioinguinal approach for anterior column acetabular fractures that is performed with a unique retraction device that decreases the rate of soft-tissue complications.
The ilioinguinal approach described by Letournel1 is the classic procedure for fractures of the anterior column of the acetabulum. This approach respects the anatomical structures of the pelvis and allows broad visual and tactile exposure of the entire anterior aspect of the ilium, the linea terminalis (pelvic brim), and the inner aspect of the posterior column1-4. However, the entire …
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