Anterior Approaches to the Acetabulum

Abstract

A number of surgical approaches exist to allow surgeons the ability to access, reduce, and stabilize acetabular fractures from both the anterior and posterior aspects of the pelvis innominate bone. The anterior approaches in particular have evolved substantially since their inception to the extent that modern acetabular fracture surgery will frequently employ one or more approaches in isolation or in combination. Importantly, while separate camps may exist that favor one “philosophy” or “style,” surgeons should recognize the importance and value of each approach such that maximal access can be obtained to optimally expose reduce and stabilize the acetabulum. For example, many surgeons that would consider themselves “purists” in their use of the ilioinguinal approach have come to utilize some form of the “Modified Stoppa” or Anterior Intrapelvic Approach as a more functional medial window for access to the quadrilateral surface and posterior column. This does not represent any form of heresy or deviation; rather, the normal and necessary evolution of surgical techniques that continue to drive the progress and improve the outcomes of fracture surgery and the art of medicine. This chapter will focus on the historical and technical aspects of the “modern” and commonly used anterior surgical exposures for acetabular fracture surgery.