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Review
. 2020 Oct 26;5(10):707-712.
doi: 10.1302/2058-5241.5.190061. eCollection 2020 Oct.

Anterior approaches to the acetabulum: which one to choose?

Tim Pohlemann  1 , Steven C Herath  1 , Benedikt J Braun  1 , Mika F Rollmann  1 , Tina Histing  1 , Antonius Pizanis  1
Affiliations
Review

Anterior approaches to the acetabulum: which one to choose?

Tim Pohlemann et al. EFORT Open Rev. .

Abstract

Surgical treatment of acetabular fractures remains challenging even for experienced surgeons.Whilst the ilioinguinal and the Kocher-Langenbeck approach remain the standard procedures to expose the anterior or posterior aspects of the acetabulum, some modified anterior approaches for the stabilization of the acetabulum have been introduced.This article will provide an overview of approaches to the anterior aspect of the acetabulum and explain the efforts that have been made to improve the surgeon's options for certain fracture modifications, such as fractures with separation of the quadrilateral surface. Cite this article: EFORT Open Rev 2020;5:707-712. DOI: 10.1302/2058-5241.5.190061.

Keywords: acetabular fracture; approach; osteosynthesis.

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Conflict of interest statement

ICMJE Conflict of interest statement: TP reports unrestricted research grants from AO Foundation, Werner, Siemens Stiftung, outside the submitted work. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
Second window of the ilioinguinal approach. (a) Lateral cutaneous nerve of the leg in this case found 1.5 centimetres medial to the anterior superior iliac spine. (b) Psoas muscle and femoral nerve with a sling placed around them to facilitate lateral retraction. (c) Langenbeck retractors expose the second window between the psoas muscle and the vessels, which are retracted medially.
Fig. 2
Fig. 2
(a) Fracture of the anterior column with associated hemitransverse fracture and displaced quadrilateral surface. (b) Reduction of the quadrilateral surface using an asymmetric pelvic reduction clamp and a plate designed to address the quadrilateral surface. (c) Fixation of the plate after reduction of the fracture and (d) postoperative result.
Fig. 3
Fig. 3
Pararectus approach. After incising the aponeurosis of the external oblique muscle, the anterior layer of the rectus sheath (a) is opened. The peritoneum (b) is retracted medially.
See this image and copyright information in PMC

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