ABSTRACT
Objective To assess the modified two-window ilioinguinal approaches used for the open reduction and internal fixation of anterior wall/column fractures of acetabulum.Methods From March 2011 to March 2012,we treated 15 patients with anterior acetabular fractures by open reduction and internal fixation.They were 13 males and 2 females,18 to 53 years of age (mean,36.8 years).According to Judet & Letournel classification,we had 6 anterior column fractures,3 transverse plus posterior wall fractures 6 double column fractures.The anterior wall/column fractures were reduced and fixated using plates and screws through 2 separate small incisions located on the symphysis pubis and the posterior part of iliac crest,respectively.The posterior components of the acetabular fractures were reduced and fixated by the Kocher-Langenbeck(K-L) approach.Only the modified two-window approaches were used for 6 anterior column fractures,and the other 9 cases used the K-L approach in addition to the modified two-window approaches.The operation time,intra-operative blood loss and postoperative complications were recorded.The quality of fracture reduction was judged according to the Matta scheme and the clinical outcome was measured using the Merle d' Aubigné-Postel rating system.Results All the 15 patients were followed for an average of 15 months (from 9 to 19 months).The mean operation time for the 15 patients was 223.3 ±85.8 minutes and the intra-operative blood loss averaged 993.3 ± 416.6 mL.Anatomical reduction was achieved in all the patients according to the Matta scheme.Lateral femoral cutaneous nerve palsy was observed in one patient but recovered spontaneously one month after operation.The mean Merle d'Aubigné-Postel score at the last follow-up was 16.9 points (from 14 to 18 points).The outcome was defined as excellent in 6 patients,good in 8 and fair in one.No more complication was observed during the follow-up period.Conclusions The modified two-window ilioinguinal approaches can be used for satisfactory reduction and fixation of the anterior wall/column or the anterior components of acetabular fractures.In addition,the modified approaches do not invade very much the soft tissues or need to expose the femoral vessels and nerves.