Transverse subgluteal-ilioinguinal approach to the acetabulum

Abstract

An approach to the acetabulum is described. This approach consists of an anterior and a posterior part. The anterior part is nearly identical with the ilioinguinal approach. The posterior part resembles Kocher's (Gibson, J Bone Joint Surg 1950;32B:183-186) original description in that the plane of dissection passes between the motor territories of the superior gluteal nerve anterolaterally and the inferior gluteal nerve posteromedially. Two modifications have been introduced, however. First, the incision is a transverse one; superior and inferior fasciocutaneous flaps are elevated. Second, the gluteus maximus is not only disinserted from the fascia lata and the gluteal tuberosity at the upper end of the femur but from the iliac crest as well. After ligating the superficial branch of the superior gluteal artery to the gluteus maximus, the muscle itself is reflected posteromedially. We have used this approach to explore the lumbosacral plexus and its branches, particularly the sciatic nerve at the greater sciatic notch. Due to the excellent exposure of both columns of the acetabulm, this approach may be equally used in fractures of the acetabulum.

Simultaneous reduction and fixation using an anatomical suprapectineal quadrilateral surface plate through modified Stoppa approach in superomedially displaced acetabular fractures

“…Traditional ilioinguinal and/or Kocher-Langenbeck approaches do not provide a sufficient surgical field for the medially displaced QLS fragment in these fractures; therefore, anatomical reduction and secure fixation of these fractures using these approaches is not easy [5][6][7][8][9] . Meanwhile, the modified Stoppa approach offers direct access to the medial aspect of the posterior column, including a QLS from the ischial spine to the greater sciatic notch 10 .…”