Treatment of displaced acetabular fractures of anterior and posterior columns using a small incision via lateral-rectus approach and percutaneous fixation

Abstract

Objective To evaluate reduction and fixation of displaced acetabular fractures of both anterior and posterior columns using a small incision via lateral-rectus approach and percutaneous fixation. Methods From January 2013 to June 2014, 11 patients with displaced acetabular fracture of both columns were surgically managed through the minimally invasive lateral-rectus approach and percutaneous fixation. They were 7 males and 4 females, with an average age of 43.2 years (from 31 to 50 years). According to Letournel-Judet classification, there were 8 anterior + posterior hemitransverse fractures and 3 both-column fractures. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The plate bended in advance was placed in the interior pelvic ring to fix the anterior column under direct vision. The ischial spine along the interior quadrilateral surface was exposed to reduce posterior column fractures. Then, the posterior column was fixed percutaneously by antegrade lag screws (6.5 mm) after a hook-wire was implanted in the posterior column along the ischial spine or ischial tuberosity. Results The operative incisions ranged from 6 to 8 cm (average, 7.0 cm); the operation time ranged from 45 to 115 min (average, 65.1 min); the intraoperative bleeding ranged from 150 to 550 mL (average, 400.3 mL). According to the Matta radiological evaluation, reduction of acetabular fractures was rated as excellent in 7 cases, good in 3 and fair in one. All patients were followed up for 6 to 12 months (average, 10 months). Their fractures united after 6 to 10 weeks (average, 8 weeks). According to the modified Merle d'Aubigne and Postel scoring system, 6 cases were excellent, 4 good, and one fair at 6 months after operation. Ectopic ossification was observed at the posterior wall at 3 months after operation in one patient. No inguinal hernia or incisional hernia was observed in the follow-ups. Conclusions A small incision via the lateral-rectus approach and percutaneous fixation for displaced acetabular fractures of anterior and posterior columns may lead to good reduction and functional outcomes with no complications, because the anterior approach offers visibility and feasibility in treating displacements of both columns. Key words: Acetabulum; Fractures, bone; Bone nails; Surgical procedures, minimally invasive; Surgical approach