The Ilioinguinal Approach: State of the Art

Abstract

Introduction: The ilioinguinal approach is the standard approach for the open reduction and internal fixation of the majority of displaced, anteriorly based acetabular fractures as it offers wide access to the acetabulum, is extensile, and has been associated with enhanced recovery.

Step 1 preoperative planning: Review the patient's general condition and imaging studies and plan the sequence of reduction and fixation.

Step 2 preparation and patient positioning: Position the patient supine on the fracture table, induce anesthesia, prepare the surgical field, administer intravenous antibiotics, and apply traction.

Step 3 ilioinguinal approach: Make a long curvilinear incision over the affected lower flank, develop the 3 working windows, and reduce and stabilize the fracture while protecting the neurovascular structures and the bladder (Video 2).

Step 4 fracture reduction and fixation: For reduction of a both-column acetabular fracture, connect the mobile parts of the acetabulum to the iliac segment that is attached to the sacrum, noting that, in most cases, the usual sequence involves the reduction of the anterior column to the intact ilium followed by the reduction of the posterior column (Video 7).

Step 5 wound closure and postoperative aftercare: Perform meticulous hemostasis, apply drains, and ensure watertight closure, which are the final steps of the operation (Video 8).

Results: The ilioinguinal approach remains 1 of the standard approaches for the management of acetabular fractures¹⁰.