![]() ![]() The ipsilateral leg is draped free into the surgical field to allow for hip flexion and traction.Īnatomical landmarks for the ilioinguinal approach are the pubic symphysis, the anterior superior iliac spine (ASIS) and the iliac crest. This option is not applied in the authors’ own practice, as the option to modify the direction of traction through the full range of motion of the hip joint allows for more specific reduction manoeuvres, and static traction can easily be maintained by the use of sterile table attachments.ĭisinfection and draping should allow access to the whole abdominal area in order to facilitate an extension of the surgical exposure in case of intraoperative vessel injuries. ![]() As an alternative option, the operation can be carried out on a specified traction table allowing for longitudinal and lateral traction of the hip. The ilioinguinal approach does not allow any visualization of the hip joint itself, therefore the correct reduction of the articular surface must be verified using absolute anatomic reduction and alignment of all accessible fracture lines as well as fluoroscopic control.įor the ilioinguinal approach, the patient is positioned supine on a radiolucent carbon table. The posterior column can only be palpated at the sciatic notch, but reduction and preliminary stabilization can be achieved using specific reduction clamps (‘King Tongs’, ‘Colinear clamps’) after anatomic reduction of the anterior column. The ilioinguinal approach as described by Letournel allows the visualization of the iliac fossa, the entire anterior column and the quadrilateral surface of the acetabulum from the pubic symphysis to the sacroiliac (SI) joint. While the Kocher-Langenbeck approach remains the standard approach to the dorsal aspect of the acetabulum, there are several anterior approaches which can be utilized for the stabilization of fractures which involve anterior structures of the acetabulum or both column fractures. Depending on the classification and specific additional fracture pattern, such as marginal impactions, intraarticular fragments and cartilage damage, the attending surgeon has to choose between the different options of anterior/posterior or rarely extended or combined surgical approaches. 1 There are five elementary fracture types, highlighted by a singular fracture line separating either the posterior or anterior wall or column, or involving both columns with a transverse fracture pattern, and combined fracture types which represent the five most frequent combinations of the elementary fracture lines. Keywords: acetabular fracture approach osteosynthesisĪccording to Emile Letournel, fractures of the acetabulum can be subdivided into ten fracture types. ![]()
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