The pararectus approach for internal fixation of acetabular fractures involving the anterior column: evaluating the functional outcome

BMC Musculoskelet Disord

et al. 2021

Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 min and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively. Conclusions The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Internal fixation of anterior acetabular fractures with a limited pararectus approach and the anatomical plates: preliminary results

BMC Musculoskelet Disord

et al. 2021

“…The functional outcome at the last follow-up were graded as good and excellent in 88.2% patients. The clinical result is comparable to the previous research (1,3,15,16,24). Good radiological and clinical results are derived from the adequate visualization of fracture sites and valid xation of the anatomical plates.…”

Section: Discussionsupporting

confidence: 84%

Internal fixation of anterior acetabular fractures with a limited pararectus approach and the anatomical plates: preliminary results

et al. 2020

Preprint

Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 minutes and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.Conclusions The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.

“…The functional outcome at the last follow-up were graded as good and excellent in 88.2% patients. The clinical result is comparable to the previous research (1,3,15,16,23). Good radiological and clinical results are derived from the adequate visualization of fracture sites and valid xation of the anatomical plates.…”

Section: Discussionsupporting

confidence: 84%

“…The pararectus approach had advantages of adequate visualization of the dome and quadrilateral plate, less complications, and easy to achieved anatomical reduction (3,(13)(14)(15). The fully exposed medial window of this approach enables direct visualization of the anterior column and quadrilateral plate, and allows palpation of the anterior aspect of the sacroiliac joint.…”

Section: Introductionmentioning

confidence: 99%

Internal Fixation of Anterior Acetabular Fractures with a Limited Pararectus Approach and the New Anatomical Plates: Preliminary Results

et al. 2020

Preprint

Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the new anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with minimally invasive approach and the new anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The new anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the new anatomical plates successfully. The mean operative time and blood loss were 90.9 minutes and 334.1 ml, respectively. The average postoperative residual gap and step displacement were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.Conclusions The limited pararectus approach with the advantages of more minimally invasive and less complications can be an alternative choice for simple anterior acetabular fractures especially involving the quadrilateral plate. The new anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction.