|
Year |
2005 |
|---|---|
|
Question Number |
8. |
|
Category |
Musculoskeletal Trauma |
Question
Which of the following factors most favors an extensile approach versus an ilioinguinal approach in the reduction and fixation of an associated both column fracture of the acetabulum?
1- Associated symphysis dislocation
2- Low anterior column component
3- Segmental posterior column component
4- Comminution of the pelvic brim
5- Lack of secondary congruence
Figures
Answer (click for answer)
PREFERRED RESPONSE: 3
The selection of the proper surgical approach for acetabular exposure is largely dependent on the fracture pattern. The ilioinguinal approach was developed by Letournel to gain access to the anterior column of the acetabulum. It’s the approach of choice for all anterior wall and column fractures as it allows exposure to the entire iliac fossa and pelvic brim from the anterior aspect of the sacroiliac joint to pubic symphysis. Both superior and inferior rami are also accessible. A posterior wall fracture does not preclude the ilioinguinal approach as this approach can be used in the majority of both column fractures. It is not recommended both column fractures associated with comminuted posterior column or sacroiliac joint involvement. In this case an extensile approach (also by Letournel) is better to access both columns, the internal iliac fossa and the retroacetabular surface.
The specific indications for the extended approach are:
1. A high (transtectal) transverse and T-type fracture pattern involving the wt bearing surface of the acetabulum.
2. Anterior column with associated posterior hemitransverse fracture
3. Both column fractures with associated posterior wall or comminuted posterior column, lateral dome involvement or SI joint extension.
4. Transverse fracture or associated fractures which have been delayed getting to the OR.
The correct answer is a both column fracture pattern with associated posterior column segmental component.
Reference: RECOMMENDED READINGS: Letournel E, Judet R (eds): Fractures of the Acetabulum, ed 2. Berlin, Germany, Springer Verlag, 1993.
Judet R, Judet J, Letournel E: Fractures of the acetabulum: Classification and surgical approaches for open reduction: Preliminary report. J Bone Joint Surg Am 1964;46:1615-1646.