Less Invasive Anterior Iliac Approach and Compression Osteosynthesis for the Treatment of High Anterior Column Fractures of the Acetabulum

ABSTRACT

BACKGROUND: Displaced anterior column fractures have increasingly been treated surgically by the ilioinguinal approach and fixation with lag screws and a buttress plate on the pelvic brim. However, a major disadvantage of the ilioinguinal approach is possible damage to the neurovascular bundle and the lymphatic structures in the intermediate part of the approach. This study aims to present a novel surgical technique of the less invasive anterior iliac approach and compression osteosynthesis for high anterior column fractures of the acetabulum. METHODS: In this retrospective case series, 19 patients treated operatively for isolated high anterior column fractures using the less invasive anterior iliac approach and compression osteosynthesis were included. Patient demographics, the cause of injury, associated injuries, time to surgical reconstruction, and operation time were collected from the medical records. The quality of reduction was assessed by postoperative standard radiographic views and computed tomography scans and graded according to Matta's criteria. Clinical and radiographic grades were assessed according to Matta's criteria at the last follow-up. RESULTS: This less invasive surgical technique was successful for reduction and fixation in all high anterior column fractures and provided sufficient stability to allow immediate mobilization of the patients after surgery. Twelve fractures were combined with the quadrilateral plate fracture and seven fractures did not involve the quadrilateral plate. According to Matta's criteria, anatomical reduction was obtained in 17 patients and imperfect reduction in two patients. Clinical results were excellent in 17 patients and good in two patients. Radiographic results were excellent in 17 patients and good in two patients. Ten patients had neurapraxia of the lateral femoral cutaneous nerve related to the approach, which was resolved completely in seven. One patient had deep vein thrombosis. CONCLUSIONS: Our less invasive surgical technique of the anterior iliac approach and compression osteosynthesis is a useful addition to the existing techniques in the treatment of high anterior column fractures of the acetabulum. Despite being a limited approach and fixation, this technique provides sufficient exposure for reducing and fixing the fracture and adequate stability to allow immediate mobilization of the patient after surgery.