Abstract
Introduction: Complex acetabular fractures often require an extensile exposure to visualise the fracture adequately. Such extensile exposures have been associated with increased morbidity. Simultaneous iliofemoral and Kocher-Langenbeck approaches offer an alternative to such exposures and do not involve sectioning of the abductor tendons or a trochanteric osteotomy. We have used simultaneous anterior and posterior exposures for complex fractures in which the transverse component is transtectal and for selected both-column fractures. This study reports on the technique and reviews 51 cases performed between 1990 and 1998.
Methods: Combined anterior and posterior surgical approaches were used in 51 of 397 acetabular fracture between 1990 and 1998. A retrospective review of the case notes of all 51 patients was performed and operative times, blood loss and complications were recorded. Pre-operative, post-operative and 12-month follow-up radiographs were assessed for fracture classification, adequacy of reduction and the development of heterotopic ossification. The presence of avascular necrosis and post-traumatic osteoarthritis were also noted.
Results: The average duration of surgery was 4 hours and 40 minutes and the average blood loss was 1735ml. A reduction within 1mm of the anatomic position was achieved in 71% of cases and within 3mm of the anatomic position in 92% of cases. There were two deep infections and two post-operative sciatic nerve palsies. There were two patients who developed Brooker grade IV heterotopic ossification.
Conclusions: Planned simultaneous iliofemoral and Kocher-Langenbeck exposures were performed with operation time, blood loss, fracture reduction and complications comparable with or better than other reported series using extensile exposures. We consider this approach a useful alternative particularly for complex fracture patterns of the acetabulum, which involve a displaced transtectal transverse component.
The abstracts were prepared by Professor A. J. Thurston. Correspondence should be addressed to him at the Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
