The treatment of acetabular fractures through the ilioinguinal approach

Abstract

The ilioinguinal approach was developed in 1965 as an anterior approach to the pelvis and acetabulum. Before this date, the Smith-Petersen incision or a modification of it called the iliofemoral approach provided the only access to the upper part of the anterior column of the acetabulum. In the current study of 195 acetabular fractures, the ilioinguinal approach was used alone in 178 cases (90%) and in combination with the Kocker-Langenbeck as a double incision in 17 cases (10%). There were 39 simple and 156 complex associated fracture patterns. There were two large groups of associated fractures: anterior column posterior hemitransverse (39 fractures) and both column fractures (98 cases). Of these fracture patterns stabilized through the ilioinguinal approach, there was a rate of perfect reduction of 85% and 73%, respectively. Of 70 fractures involving the anterior column, anterior wall, and anterior column posterior hemitransverse, there were 61 perfect reductions (87%). The complication rate was extremely low, without any evidence of external iliac fossa heterotopic ossification. The ilioinguinal approach provides total and complete access to the anterior column from the sacroiliac joint to the pubic symphysis. An experienced acetabular surgeon may achieve excellent results even with complex fracture patterns.