Treatment of acetabular fractures involving the anterior column through the paramedian approach

Abstract

Objective To explore the surgical techniques and clinical efficacy of the paramedian approach in the treatment of acetabular fractures involving the anterior column. Methods From August 2013 to December 2014, 56 patients with acetabular fracture were treated through the paramedian approach. They were 34 men and 22 women, aged from 29 to 58 years (average, 38 years) . According to Letournel-Judet classification, 12 cases were anterior column fracture, 18 cases fracture of anterior column plus posterior hemitransverse, 9 cases transverse fracture, 6 cases T-shape fracture, and 11 cases both column fracture. All patients were treated by open reduction and internal fixation through the paramedian approach after general anesthesia. After an abdominal midline longitudinal incision was made, the rectus abdominis anterior sheath was cut longitudinally 2-3 cm para-linea alba. After the rectus abdominis was retracted to the lesion side, the rectus abdominis posterior sheath was cut to expose the deep pelvic fracture. In the 12 patients who had been complicated with iliac wing fracture, an additional iliac fossa approach was used. Results The mean surgical time was 105 min (range, from 96 to 188 min) ; the mean blood lose was 400 mL (range, from 200 to 800 mL) ; red cell transfusion was 2.4 units (range, from 0 to 4 units) . The 56 patients were followed up for an average of 16 months (range, from 6 to 22 months) . According to the Matta's fracture reduction assessment, 38 cases were excellent, 11 good, 4 fair, and 3 poor, giving a good-to-excellent rate of 87.5%. All factures healed within 3 months. According to the modified Merle d'Aubigne & Postel scoring at the end of follow-up, the hip joint function was rated as excellent in 34 cases, good in 12, fair in 6 and poor in 4, giving a good-to-excellent rate of 82.1%. No abdominal wall hernias, wound infection or injury to major nerves or vessels was observed during follow-up. Conclusions In the treatment of acetabular fractures involving the anterior column, the paramedian approach can fully reveal anterior wall, anterior column and posterior column of the acetabulum. It is easy to handle and unlikely to injure major vessels and nerves. It also leads to less blood loss. This approach can be used for the majority of acetabular fractures involving the anterior column. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Paramedian approach