CURRENT CONCEPTS REVIEW SOUBORNÝ REFERÁT-isolated fractures of the anterior wall, -isolated fractures of the anterior column, -fractures of the anterior column with a posterior hemitransverse fracture, -both-column fractures with a single large minor displaced posterior column fragment, -certain transverse and T-type fractures.
ContraindicationsIn analogy to the given indications, fractures with a main posterior pathology as well as intra-articular concomitant injuries, that cannot be addressed indirectly (e.g. posterior marginal impactions) are better indications for a posterior approach. Therefore, the following fracture types are considered contraindications for the single use of the ilioinguinal approach: • isolated fractures of the posterior wall, • isolated fractures of the posterior column, • associated posterior column and posterior wall fractures, • associated fractures with an additional displaced posterior wall fragment, • fractures with significant posterior displacement, which cannot be reduced from anteriorly, • fractures with posterior marginal impactions.
ExposureThe classical ilioinguinal approach allows direct visualization of the complete iliac fossa, the more or less complete area of the linea terminalis from the pubic symphysis to the SI-joint and parts of the quadrilateral surface. By palpation, the posterior column can be indirectly felt in the area of the greater sciatic notch and at the quadrilateral surface. The outer side of the iliac wing is not routinely dissected (Fig. 1). By modifying the classical approach additional portions of the pelvis can be visualized (2,4,6,7,12), (see below).
PositioningThe standard position of the patient is the supine position on a radiolucent table allowing the standard X-rays (a.p.-pelvis, Judet views, combined oblique pelvic ring and Judet views). Rotation of the patient around his long axis on the table should be possible.