Abstract
Associated acetabular fractures are challenging injuries to manage. The complex surgical approaches and the technical difficulty in achieving anatomical reduction imply that the learning curve to achieve high-quality care of patients with such challenging injuries is extremely steep. This first article in the Journal’s “Safe Surgical Technique” section presents the standard surgical care, in conjunction with intraoperative tips and tricks, for the safe management of all subgroups of associated acetabular fractures.
Highlights
The anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular fracture patterns
Operative procedure Reduction of the posterior column fracture provides for a stable surface to reduce the posterior wall fracture
The intra-articular surface may be directly visualized by reflecting the posterior wall fragments in continuity with the joint capsule and by distracting the hip joint
Summary
The anatomic reduction remains the rationale for the surgical reduction and fixation of associated acetabular fractures, and is not different from simple acetabular fracture patterns. Tips and tricks The modified Stoppa approach developed by Cole et al [18] or the modified ilioinguinal approach reported by Karunakar et al [19] that uses the midline incision instead of the third window of the standard ilioinguinal approach, is often useful to treat associated anterior column and posterior hemitransverse, T-shaped, and both column fractures, especially in the case that the quadrilateral surface is not comminuted and the posterior fragment is relative large This allows access to the pubic symphysis, pubic rami, the whole quadrilateral surface, the inner aspect of the greater sciatic notch, and Figure 13 Example of a T-shaped fracture treated via a combined ilioinguinal and Kocher-Langenbeck approach, using two 3.5 mm reconstruction plates and two 3.5 mm lag screws. The jaw located proximal to this clamp is placed on the pelvic brim with its tip anchored on the posterior edge of the quadrilateral surface or ischial spine, and can pull the posterior column up to anterior column by pulling the trigger like a gun (Figure 18)
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