Surgical evaluation of lateral-rectus approach for treatment of acetabular fracture combined with ipsilateral pelvic fracture

Abstract

Objective To explore the clinical effect of lateral-rectus approach for treatment of acetabular fracture combined with ipsilateral pelvic fracture. Methods From January 2010 to February 2014, 24 patients with acetabular fracture combined with ipsilateral pelvic fracture were surgically managed through the lateral-rectus approach. Eighteen cases of merely anterior acetabular and pelvic fractures were treated with the lateral-rectus approach only, in the supine position. Six cases involving the posterior acetabular wall and posterior column were treated with the lateral-rectus approach combined lateral-rectus and posterior Kocher-Langenbeck approaches, in the floating position. The titanium reconstruction plates and cannulated screws were applied in these cases. Results The operation time was 70-185 min and the intraoperative blood loss was 420-1 100 ml. Postoperative X-ray and CT exams showed excellent and good reduction. According to the postoperative Matta radiological evaluation, reduction of acetabular fracture was rated as anatomic in 13 cases, with satisfactory reduction in 8 cases and unsatisfactory in 3 cases. Injury to the sciatic nerve occurred in one case, and fat liquefaction at the abdominal incision in one case. All the patients were followed up for 13-30 months and the fractures healed after 10-16 weeks. According to the modified Merle d'Aubigne and Postel scoring system, 16 cases were excellent, 6 cases were good and 2 cases were fair 6 months after operation. Conclusions Surgical management of acetabular fractures through the lateral-rectus approach can provide adequate exposure and treatment for not only the acetabular fractures involving the anterior column and the quadrilateral surface, but also ipsilateral fractures involving the pubic superior ramus, iliac ala and sacroiliac joint, leading to fine outcomes. Key words: Fractures; Acetabulum; Pelvis; Approach