AN ANATOMICAL STUDY AND CLINICAL EVALUATION OF MODIFIED SUBINGUINAL APPROACH FOR TREATMENT OF ACETABULAR FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QINXiaodong , LIXiang , LÜTianrun , SONGLijun , ZHANGNing ,  FANWeimin

Department of Orthopedic Trauma, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210029, P. R. China;

Corresponding author：

FANWeimin, Email: fanweimin@vip.sina.com

Keywords：

Acetabular fracture; Modified subinguinal approach; Internal fixation; Open reduction

DOI：

10.7507/1002-1892.20140011

Video：

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Objective To investigate the clinical results of modified subinguinal approach without iliac osteotomy for anterior surgical treatment of acetabular fractures which involve the anterior wall and medial wall or in combination with femoral neck fracture. Methods The subinguinal approach was modified after anatomical study on 12 adult cadavers. Between May 2010 and March 2012, 34 patients with acetabular fracture that involved the anterior wall and medial wall or in combination with femoral neck fracture were treated with open reduction and internal fixation through modified subinguinal approach in 15 cases and through modified subinguinal approach combined with Kocher-Langenbeck approach. There were 28 males and 6 females with an average age of 31.1 years (range, 20-64 years). According to the Letournel-Judet classification, there were 15 cases of anterior acetabular/column fractures, 8 cases of anterior acetabular/column fractures combined with trear half transverse fractures, 7 cases of double column fractures, and 4 cases of T shape fractures. The time between injury and operation was 5-16 days (mean, 7.4 days). Results Anatomy results: the inguinal ligament was reflection and continuity from the aponeurosis of obliquus externus abdominis with a length of (11.09±0.24) cm, which form part of abdominal muscle. The conjugate of inguinal ligament and iliopsoas muscle on the anterosuperior iliac spine was (0.69±0.08) cm. The vertical distance from the saphenous vein to the inguinal ligament was (3.58±0.49) cm. Clinical results: all the cases were followed up 4-24 months (mean, 14.6 months). No complication was observed, such as wound infection, internal fixation loosening, and iatrogenic injury to the sciatic or femoral nerve. The bone union time was 12-16 weeks (mean, 14 weeks). According to Matta reduction criteria for acetabular fractures, anatomic reduction were achieved in 21 cases, satisfactory reduction in 10 cases, and unsatisfactory reduction in 3 cases at 1 week after operation. According to D'Aubigne and Postel criteria for hip function, the results were excellent in 25 cases, good in 4 cases, fair in 3 cases, and poor in 2 cases at last follow-up. Heterotopic ossification (Brooker's grade I) occurred in 8 cases. Conclusion The modified subinguinal approach can keep the inguinal ligament intact, provide broad visualization of anterior and medial wall of acetabulum and anterior hip capsule, which is a better modification and supplement for classic ilioinguinal approach.

Citation： QINXiaodong, LIXiang, LÜTianrun, SONGLijun, ZHANGNing, FANWeimin. AN ANATOMICAL STUDY AND CLINICAL EVALUATION OF MODIFIED SUBINGUINAL APPROACH FOR TREATMENT OF ACETABULAR FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 47-52. doi: 10.7507/1002-1892.20140011 Copy

1.	Letournel E.The treatment of acetabular fractures through the ilioinguinal approach.Clin Orthop Relat Res,1993,(292):62-76.
2.	Matta JM.Operative treatment of acetabular fractures through the ilioinguinal approach.A 10-year perspective.Clin Orthop Relat Res,1994,(305):10-19.
3.	Matta JM.Indications for anterior fixation of pelvic fractures.Clin Orthop Relat Res,1996,(329):88-96.
4.	Kloen P,Siebenrock KA,Ganz R.Modification of the ilioinguinal approach.J Orthop Trauma,2002,16(8):586-593.
5.	Karunakar MA,Le TT,Bosse MJ.The modified ilioinguinal approach.J Orthop Trauma,2004,18(6):379-383.
6.	Lefaivre KA,Starr AJ,Reinert CM.A modified anterior exposure to the acetabulum for treatment of difficult anterior acetabular fractures.J Orthop Trauma,2009,23(5):370-378.
7.	Beaulé PE.A modified anterior exposure to the acetabulum for treatment of diffcult anterior acetabular fractures.J Orthop Trauma,2009,23(10):749-750.
8.	Keel MJ,Ecker TM,Cullmann JL,et al.The ararectus approach for anterior intrapelvic management of acetabular fractures:an anatomical study and clinical evaluation.J Bone Joint Surg (Br),2012,94(3):405-411.
9.	Farid YR.The subinguinal retroperitoneal approach for fractures of the acetabulum:a modified ilioinguinal approach.J Orthop Trauma,2008,22(4):270-275.
10.	蔚芃,宋超敏,明伟,等.改良髂股延长入路治疗复杂髋臼骨折.中国修复重建外科杂志,2006,20(8):838-839.
11.	Keel MJ,Ecker TM,Siebenrock KA,et al.Rationales for the Bernese approaches in acetabular surgery.Eur J Trauma Emerg Surg,2012,38(5):489-498.
12.	Bastian JD,Tannast M,Siebenrock KA,et al.Mid-term results in relation to age and analysis of predictive factors after fixation of acetabular fractures using the modified Stoppa approach.Injury,2013,44(12):1793-1798.
13.	Liu Y,Yang H,Li X,et al.Newly modified Stoppa approach for acetabular fractures.Int Orthop,2013,37(7):1347-1353.
14.	Ma K,Luan F,Wang X,et al.Randomized,controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures.Orthopedics,2013,36(10):e1307-1315.
15.	秦晓东,李翔,吕天润,等.髂腹股沟下入路在髋臼骨折治疗中的初步应用.中华创伤骨科杂志,2010,12(10):936-939.
16.	Matta JM.Fractures of the acetabulurn:accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury.J Bone Joint Surg (Am),1996,78(11):1632-1645.
17.	Brooker AF,Bowerman JW,Robinson RA,et al.Ectopic ossification following total hip replacement:incidence and a method of classification.J Bone Joint Surg (Am),1973,55(8):1629-1632.
18.	Seyyed Hosseinzadeh HR,Eajazi A,Hassas Yeganeh M,et al.Modified ilioinguinal approach to the acetabulum and pelvis from beneath the inguinal ligament:a subinguinal approach.Hip Int,2010,20(2):150-155.

1. Letournel E.The treatment of acetabular fractures through the ilioinguinal approach.Clin Orthop Relat Res,1993,(292):62-76.
2. Matta JM.Operative treatment of acetabular fractures through the ilioinguinal approach.A 10-year perspective.Clin Orthop Relat Res,1994,(305):10-19.
3. Matta JM.Indications for anterior fixation of pelvic fractures.Clin Orthop Relat Res,1996,(329):88-96.
4. Kloen P,Siebenrock KA,Ganz R.Modification of the ilioinguinal approach.J Orthop Trauma,2002,16(8):586-593.
5. Karunakar MA,Le TT,Bosse MJ.The modified ilioinguinal approach.J Orthop Trauma,2004,18(6):379-383.
6. Lefaivre KA,Starr AJ,Reinert CM.A modified anterior exposure to the acetabulum for treatment of difficult anterior acetabular fractures.J Orthop Trauma,2009,23(5):370-378.
7. Beaulé PE.A modified anterior exposure to the acetabulum for treatment of diffcult anterior acetabular fractures.J Orthop Trauma,2009,23(10):749-750.
8. Keel MJ,Ecker TM,Cullmann JL,et al.The ararectus approach for anterior intrapelvic management of acetabular fractures:an anatomical study and clinical evaluation.J Bone Joint Surg (Br),2012,94(3):405-411.
9. Farid YR.The subinguinal retroperitoneal approach for fractures of the acetabulum:a modified ilioinguinal approach.J Orthop Trauma,2008,22(4):270-275.
10. 蔚芃,宋超敏,明伟,等.改良髂股延长入路治疗复杂髋臼骨折.中国修复重建外科杂志,2006,20(8):838-839.
11. Keel MJ,Ecker TM,Siebenrock KA,et al.Rationales for the Bernese approaches in acetabular surgery.Eur J Trauma Emerg Surg,2012,38(5):489-498.
12. Bastian JD,Tannast M,Siebenrock KA,et al.Mid-term results in relation to age and analysis of predictive factors after fixation of acetabular fractures using the modified Stoppa approach.Injury,2013,44(12):1793-1798.
13. Liu Y,Yang H,Li X,et al.Newly modified Stoppa approach for acetabular fractures.Int Orthop,2013,37(7):1347-1353.
14. Ma K,Luan F,Wang X,et al.Randomized,controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures.Orthopedics,2013,36(10):e1307-1315.
15. 秦晓东,李翔,吕天润,等.髂腹股沟下入路在髋臼骨折治疗中的初步应用.中华创伤骨科杂志,2010,12(10):936-939.
16. Matta JM.Fractures of the acetabulurn:accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury.J Bone Joint Surg (Am),1996,78(11):1632-1645.
17. Brooker AF,Bowerman JW,Robinson RA,et al.Ectopic ossification following total hip replacement:incidence and a method of classification.J Bone Joint Surg (Am),1973,55(8):1629-1632.
18. Seyyed Hosseinzadeh HR,Eajazi A,Hassas Yeganeh M,et al.Modified ilioinguinal approach to the acetabulum and pelvis from beneath the inguinal ligament:a subinguinal approach.Hip Int,2010,20(2):150-155.

Chinese Journal of Reparative and Reconstructive Surgery

AN ANATOMICAL STUDY AND CLINICAL EVALUATION OF MODIFIED SUBINGUINAL APPROACH FOR TREATMENT OF ACETABULAR FRACTURES

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