Treatment of complex acetabular fractures through a modified extended iliofemoral approach.
OBJECTIVE
To assess the rate of anatomic reconstructions as well as approach-related morbidity and complications in the treatment of complex acetabular fractures through a modified extended iliofemoral approach.


METHODS
Prospective clinical study.


METHODS
Level I trauma center, University Hospital.


METHODS
Inclusion criteria were as follows: (a) associated acetabular fracture or transverse fracture with comminuted roof area stated as not sufficiently reconstructable through a single approach, and (b) age between sixteen and sixty-five years. A total of forty-nine patients with fifty complex acetabular fractures could be included out of the series of ninety-six acetabular fractures treated operatively from August 1992 to February 1996. Open reduction and internal fixation of complex acetabular fractures through the modified extended iliofemoral approach were performed.


RESULTS
In 80 percent of the fifty fractures the reduction was anatomic with a remaining displacement of less than or equal to one millimeter, in eight cases there was a persistent displacement of two millimeters, and two fractures had a poor result with a three-millimeter displacement. Complications included 8 percent loss of reduction, 13 percent heterotopic ossification grade 3, and 4 percent avascular femoral head necrosis. At the two-year follow-up there were 74 percent good or excellent radiographic and clinical results. Two patients had already been reoperated with total hip replacement, and the two patients with femoral head necrosis are currently scheduled for arthroplasty.


CONCLUSIONS
The modified extended iliofemoral approach proved to be appropriate to achieve anatomic reduction in complex acetabular fractures. The high rate of approach-related morbidity has to be considered carefully and may lead to a decreased incidence of extended approaches.
Stöckle
U
U
Department of Trauma and Reconstructive Surgery Charité, Humboldt University, Berlin Germany.
Hoffmann
R
R
Südkamp
N P
NP
Reindl
R
R
Haas
N P
NP
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome