Complications following the "T extensile" approach: a modified extensile approach for acetabular fracture surgery-report of forty-three patients

Abstract

Objective: Analyze the prevalence and severity of surgical complications encountered with a modified extended iliofemoral approach, the "T extensile" approach, in the treatment of complex acetabular fractures.

Study design: Prospective.

Methods: During a sixteen-month study period, forty-three patients with complex acetabular fractures were treated via the T extensile approach. Perioperative antibiotics were used to prevent infection, and prophylaxis for heterotopic ossification was done with postoperative irradiation. Complications and clinical results were recorded. The patients were followed for an average of thirty months.

Results: Acceptable reductions were obtained in forty patients. Poor reductions were obtained in three patients. There were no infections or iatrogenic nerve injuries. Brooker Grade 1 heterotopic ossification was seen in nineteen patients, eight had Grade 2, two had Grade 3, and no heterotopic ossification was seen in the other fourteen patients. No patient who received radiation developed heterotopic ossification beyond Brooker Grade 2. Seven patients went on to require total hip arthroplasty. The remaining thirty-six patients had an average Harris Hip Score of 86.

Conclusions: Extensile exposures to the acetabulum can be safely carried out with limited morbidity, as long as appropriate steps are taken to limit predictable complications.