Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2019 Jul;32(3):157-164. Korean.
    Published online Jul 24, 2019.
    https://doi.org/10.12671/jkfs.2019.32.3.157
    Copyright © 2019 The Korean Fracture Society. All rights reserved.
    Review

    Anterior Approach for the Acetabular Fractures

    Jae Youn Yoon, M.D., Jae-Woo Cho, M.D.,* and Ji Wan Kim, M.D., Ph.D.
      • Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
      • *Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
    • Correspondence to: Ji Wan Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3530, Fax: +82-2-488-7877, Email: bakpaker@hanmail.net
    Received June 25, 2019; Revised June 25, 2019; Accepted June 25, 2019.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    In the surgical treatment of acetabular fractures, the anterior approach is used widely for anterior column fractures with or without posterior column fractures. This paper reviews the anterior approach for the anatomical reduction and rigid fixation of acetabular fractures: traditional ilioinguinal approach, modified Stoppa approach, and new Pararectal approach.

    Keywords
    Acetabulum; Acetabular fracture; Approach

    Figures

    Fig. 1
    Ilioinguinal approach. (A) Skin incision from the symphysis pubis to the iliac crest. (B) Incision of the inguinal ligament. (C) Iliopectineal fascia. (D) Exposure of the lateral window (white arrow: lateral femoral cutaneous nerve, black arrow: iliopectineal fascia). (E) Exposure of the ilium and anterior sacroiliac joint through the lateral window. (F) Three windows (1: lateral window, 2: middle window, 3: medial window, m: lacuna musculorum, v: lacuna vasorum, s: spermatic cord).

    Fig. 2
    Modified Stoppa approach. (A) Skin incision-like Pfannelstiel incision; 10 cm transverse incision 2 cm above the symphysis pubis. (B) Subcutaneous dissection. (C) Incision of the fascia (linea alba) of the rectus abdominis. (D) Deep blunt dissection along the superior pubic ramus. (E) Identification of the obturator nerve. (F) Exposure of the quadrilateral surface.

    Fig. 3
    Modified Stoppa approach for a bilateral pelvis ring injury and right acetabular fracture. (A) Initial pelvis X-ray showing the right acetabular anterior column fracture with the right sacral alar fracture and left pubic fracture. (B, C) Three-dimensional reconstruction images. (D) Postoperative pelvis anteroposterior.

    Fig. 4
    Pararectal approach. (A) Skin incision. (B) Exposure of the deep fascia. (C) Incision of the rectus sheath. (D) Exposure of the lateral border of the rectus abdominis and retroperitoneal fat. (E) Schematic diagrams of the approach for the retroperitoneal space. (F) Exposure of the anterior column. (G) Reduction of the anterior and posterior column with a Collinear clamp.

    Fig. 5
    Number of journals published worldwide related to each anterior pelvic approach in acetabular fractures.

    Fig. 6
    Illustrated images on the range of surgical exposure, according to the type of anterior pelvic approach. (A) Ilioinguinal approach. (B) Modified Stoppa approach. (C) Pararectal approach.

    Tables

    Table 1
    Comparison of the Anterior Approach

    Notes

    Financial support:None.

    Conflict of interests:None.

    References

      1. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res 1993;(292):62–76.
      1. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res 1994;(305):112–123.
      1. Andersen RC, O'Toole RV, Nascone JW, Sciadini MF, Frisch HM, Turen CW. Modified stoppa approach for acetabular fractures with anterior and posterior column displacement: quantification of radiographic reduction and analysis of interobserver variability. J Orthop Trauma 2010;24:271–278.
      1. Archdeacon MT, Kazemi N, Guy P, Sagi HC. The modified Stoppa approach for acetabular fracture. J Am Acad Orthop Surg 2011;19:170–175.
      1. Hirvensalo E, Lindahl J, Kiljunen V. Modified and new approaches for pelvic and acetabular surgery. Injury 2007;38:431–441.
      1. Kim JW, Kim YC. Modified Stoppa approach in acetabular fractures. J Korean Fract Soc 2014;27:274–280.
      1. Keel MJ, Ecker TM, Cullmann JL, et al. The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg Br 2012;94:405–411.
      1. Tosounidis TH, Giannoudis VP, Kanakaris NK, Giannoudis PV. The Ilioinguinal approach: state of the art. JBJS Essent Surg Tech 2018;8:e19
      1. Elmadağ M, Güzel Y, Acar MA, Uzer G, Arazi M. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res 2014;100:675–680.
      1. Ruchholtz S, Buecking B, Delschen A, et al. The two-incision, minimally invasive approach in the treatment of acetabular fractures. J Orthop Trauma 2013;27:248–255.
      1. Jimenez ML, Tile M, Schenk RS. Total hip replacement after acetabular fracture. Orthop Clin North Am 1997;28:435–446.
      1. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. J Orthop Trauma 2006;20:S20–S29.
      1. Stoppa RE, Rives JL, Warlaumont CR, Palot JP, Verhaeghe PJ, Delattre JF. The use of Dacron in the repair of hernias of the groin. Surg Clin North Am 1984;64:269–285.
      1. Kim JW, Seo YM, Jang HS. Reduction technique of dome impaction using the modified Stoppa approach - a technical note -. J Korean Fract Soc 2017;30:131–136.
      1. Tannast M, Keel MJB, Siebenrock KA, Bastian JD. Open reduction and internal fixation of acetabular fractures using the modified Stoppa approach. JBJS Essent Surg Tech 2019;9:e3
      1. Sagi HC, Afsari A, Dziadosz D. The anterior intra-pelvic (modified rives-stoppa) approach for fixation of acetabular fractures. J Orthop Trauma 2010;24:263–270.
      1. Keel MJ, Bastian JD, Büchler L, Siebenrock KA. [Anterior approaches to the acetabulum]. Unfallchirurg 2013;116:213–220.
        German.
      1. Kloen P, Siebenrock KA, Ganz R. Modification of the ilioinguinal approach. J Orthop Trauma 2002;16:586–593.
      1. Laflamme GY, Hebert-Davies J, Rouleau D, Benoit B, Leduc S. Internal fixation of osteopenic acetabular fractures involving the quadrilateral plate. Injury 2011;42:1130–1134.
      1. Keel MJB, Siebenrock KA, Tannast M, Bastian JD. The Pararectus approach: a new concept. JBJS Essent Surg Tech 2018;8:e21
      1. Bastian JD, Savic M, Cullmann JL, Zech WD, Djonov V, Keel MJ. Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa. Injury 2016;47:695–701.
      1. Märdian S, Schaser KD, Hinz P, Wittenberg S, Haas NP, Schwabe P. Fixation of acetabular fractures via the ilioinguinal versus pararectus approach: a direct comparison. Bone Joint J 2015;97:1271–1278.
      1. Keel MJ, Tomagra S, Bonel HM, Siebenrock KA, Bastian JD. Clinical results of acetabular fracture management with the Pararectus approach. Injury 2014;45:1900–1907.
      1. Bastian JD, Tannast M, Siebenrock KA, Keel MJ. Mid-term results in relation to age and analysis of predictive factors after fixation of acetabular fractures using the modified Stoppa approach. Injury 2013;44:1793–1798.
      1. Isaacson MJ, Taylor BC, French BG, Poka A. Treatment of acetabulum fractures through the modified Stoppa approach: strategies and outcomes. Clin Orthop Relat Res 2014;472:3345–3352.
      1. Ma K, Luan F, Wang X, et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics 2013;36:e1307–e1315.
      1. Shazar N, Eshed I, Ackshota N, Hershkovich O, Khazanov A, Herman A. Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified Rives-Stoppa) surgical approaches. J Orthop Trauma 2014;28:313–319.
      1. Hammad AS, El-Khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches. Injury 2015;46:320–326.
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    Acetabulum*
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