[Reconstruction of fractures of the anterior wall and the anterior column of the acetabulum using an ilioinguinal approach].
OBJECTIVE
Restoration of the congruence of the hip joint. Correction of gaps or steps in the articular surface, especially in the main weight-bearing area of the acetabular dome. Correction of femoral head subluxation. Restoration of joint stability in order to enable early postoperative mobilization.


METHODS
Fractures of the anterior wall and/or column that are characterized by intraarticular gaps or steps of > 1 mm in the area of the main weight-bearing dome of the acetabulum. Fractures complicated by subluxation or dislocation of the femoral head.


METHODS
Poor general physical condition and/or dementia. Critical soft-tissue conditions in the area near the surgical approach. Local soft-tissue infection. Preexisiting severe osteoarthritis of the hip joint.


METHODS
Exposure of the fracture through an ilioinguinal approach. Reduction of a subluxated femoral head. Reduction of the anterior column and/or wall. Correction of articular gaps, steps and areas of joint impression. Internal fixation using small-fragment reconstruction plates, if required in combination with additional screws.


METHODS
Postoperative radiographs for the documentation of the surgical result and implant position (exclusion of intraarticular implants). Postoperative computed tomography, if indicated. Active and passive exercises of the hip joint starting on day 1. Hip joint flexion limited to 90 degrees . Prophylaxis of thrombosis until full weight bearing, starting preoperatively. Mobilization without weight bearing or 15 kg partial weight bearing for 8-12 weeks. Progressive weight bearing over a time period of 4-6 weeks. Radiologic evaluation after 2, 6, and 12 weeks as well as after 6, 12, and 24 months.


RESULTS
Excellent and good functional results are observed in 73-85% of the isolated anterior column fractures. The anterior wall fracture is a seldom injury. Functional results are worse in comparison to the other simple fracture types. Good or excellent results can only be observed in two thirds of cases. This observation is related to the fact that anterior wall fractures often occur in elderly patients with osteoporotic bone.
Klinik für Orthopädie und Unfallchirurgie, Klinikum Fulda, Fulda, Germany. uo@klinikum-fulda.de
Martin Henri
MH
Hessmann
Patrick
P
Ingelfinger
Sven Oliver
SO
Dietz
Pol Maria
PM
Rommens
D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000601:surgery; D007264:Inguinal Canal / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*