Clinical Results of Acetabular Fracture via the Pararectus versus Ilioinguinal Approach

Abstract

Objective: To compare the clinical efficacy of pararectus and ilioinguinal approach in the treatment of acetabular fractures.

Methods: A retrospective analysis of the clinical data of 60 patients with acetabular fractures treated by the pararectus approach or the ilioinguinal approach from January 2016 to January 2019 was performed to record all data by comparing the length of the surgical incision, the time to expose the fracture and the amount of blood loss during the operation. Patients were routinely followed up at 1, 6 and 12 months postoperatively. The function of the hip joint after the operation (Improved Merle d' Aubigne and Postel scores) and the complications postoperation were recorded.

Results: There was a significant difference (mean ± SD) in the length of surgical incision [(11.2 ± 1.5) cm vs.(23.8 ± 2.1) cm], and in surgical exposure time [(10.8 ± 1.7) min vs.(19.9 ± 1.9) min] (P < 0.05) between the two approaches; there was no significant difference (mean ± SD) in intraoperative blood loss [(591.8 ± 131.4) mL vs. (614.6 ± 132.7) mL] or in hip function scores at the last follow-up between the two groups (P > 0.05). In the pararectus approach group, there was one patient (3.3%) with postoperative wound fat liquefaction, and the wound completely improved by secretion culture, enhanced dressing and effective antibiotics, one patient (3.3%) developed lateral femoral cutaneous nerve injury; One case (3.3%) of postoperative myositis ossificans occurred in the ilioinguinal approach group, and there were no obvious symptoms.

Conclusions: These data suggest that for patients with acetabular fractures, both the pararectus approach and the ilioinguinal approach can achieve satisfactory surgical results, but the former has relatively simple operation and small incision length, which is in line with the modern concept of the minimally invasive pelvis.

Keywords: Acetabular fracture; Fracture fixation; Ilioinguinal approach; Pararectus approach; Surgical method.

Fig. 1

Landmarks and the skin incision of the pararectus approach. The incision starts at the middle and outer 1/3 of the line connecting the umbilical cord with the ASIS, and stops at the middle and inner 1/3 of the line connecting the ASIS with pubic symphysis.

Fig. 2

Diagram of the surgical exposure, showing (A) genital femoral nerve, (B) external iliac artery/vein, (C) iliac psoas muscle, (D) obturator nerve, (E) obturator vessels, (F) spermatic cord in men or round ligament in women, (G)”death crown”, (H) inferior abdominal artery/vein.

Fig. 3

Intraoperative images can clearly reveal important structures.(A) iliac psoas muscle, (B) external iliac artery/vein, (C) spermatic cord, (D) inferior abdominal artery/vein.