title: Transsection of the rectus abdominis muscle in the treatment of acetabular fractures: operative technique and outcome in 21 patients.
abstract: BACKGROUND
  A standard ilioinguinal approach is often insufficient for reduction and stabilization of the medial acetabular wall and the dorsal column in acetabular fractures. To avoid extended approaches, we have used a medial extension of the approach by transverse splitting of the rectus abdominis muscle. We have thus been able to reduce and stabilize transverse and oblique fractures of the dorsal column and the medial acetabular wall and to fix plates in a mechanically better position below the pelvic brim. To evaluate the procedure, especially the risk of abdominal hernia, we started a prospective study.
  
  
  METHODS
  Over 2 years, we treated 21 consecutive patients using a transverse splitting of the rectus abdominis muscle-either as an extension of the standard ilioinguinal approach or in combination with parts of this approach or a Kocher-Langenbeck approach. The patients were evaluated clinically and radiographically after 1 year.
  
  
  RESULTS
  The clinical and radiographic results were excellent or good in 18 patients. Complications occurred in 5 patients. No hernias were observed.
  
  
  CONCLUSIONS
  Our small study indicates that the procedure described is a useful and safe complement to the intrapelvic approaches. The procedure does not provide better reduction than extended approaches, but may help to avoid them in some cases.
authors.affiliation: Klinikfur Unfall- u, Wiederherstellungschirurgie des Universitatsklinikums Carl Gustav Carus, Dresden, Germany. jan.heineck@uniklinikum-dresden.de
authors.forename: Jan
authors.initials: J
authors.lastname: Heineck
authors.forename: Stefan
authors.initials: S
authors.lastname: Rammelt
authors.forename: Rene
authors.initials: R
authors.lastname: Grass
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schneiders
authors.forename: Michael
authors.initials: M
authors.lastname: Amlang
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000601:surgery*; D016896:Treatment Outcome