title: Minimal invasive para-rectus approach for limited open reduction and percutaneous fixation of displaced acetabular fractures.
abstract: BACKGROUND
  Minimal invasive fixation has been reported as an alternative option for treatment of acetabular fractures to avoid blood loss and complications of extensive approaches. Closed reduction and percutaneous lag screw fixation can be done in minimally displaced acetabular fractures. Open reduction is indicated, if there is wide displacement. In this study, we report the use of a mini-open anterior approach to manipulate and reduce anteriorly displaced transverse acetabular fractures combined with percutaneous lag screw fixation.
  
  
  METHODS
  This report included eight patients. All had anterior displaced simple transverse acetabular fractures. An oblique mini-incision was made above and medial to the mid-inguinal point, and lateral to the lateral border of rectus abdominis muscle. The external abdominal oblique aponeurosis was incised along its fibres. The arched fibres of internal abdominal oblique were displaced medially above the inguinal ligament to expose and incise the fascia transversalis. Care was taken to avoid injury of ilioinguinal nerve, inferior epigastric vessels, and spermatic cord. The external iliac vessels were palpated and protected laterally. A blunt long bone impactor was introduced through this small incision to manipulate and reduce the fracture under fluoroscopic control. Fluoroscopic guided percutaneous lag screw fixation was done in all patients.
  
  
  RESULTS
  The average time to operation was 4 days. Average blood loss was 110mL. Operative time averaged 95min. Maximum fracture displacement averaged 10mm preoperatively and 1.3mm postoperatively. According to Matta score, anatomical reduction of the fracture was achieved in five patients and imperfect in three. Follow up averaged 27 months. Wound healing occurred without complications and fracture union was achieved without secondary displacement in all patients. Average time to fracture healing was 14 weeks. According to the modified Merle d'Aubigné score, functional outcome was good to excellent in all patients.
  
  
  CONCLUSIONS
  Limited open reduction can solve the problem of fracture reduction, which is the main concern in minimal invasive fixation of acetabular fractures. It may help the inclusion of displaced acetabular fractures for percutaneous lag screw fixation. This mini-para-rectus approach has the advantages of minimal soft tissue dissection with the possible anatomical reduction of simple transverse displaced acetabular fractures.
authors.affiliation: Orthopaedic Department, Assiut University Hospitals, 71526 Assiut, Egypt. Electronic address: osama_farouk@yahoo.com.
authors.forename: Osama
authors.initials: O
authors.lastname: Farouk
authors.affiliation: Trauma Unit, Assiut University Hospitals, 71526 Assiut, Egypt.
authors.forename: Ayman
authors.initials: A
authors.lastname: Kamal
authors.affiliation: Orthopaedic Department, Assiut University Hospitals, 71526 Assiut, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Badran
authors.affiliation: Orthopaedic Department, Assiut University Hospitals, 71526 Assiut, Egypt.
authors.forename: Wael
authors.initials: W
authors.lastname: El-Adly
authors.affiliation: Orthopaedic Department, Assiut University Hospitals, 71526 Assiut, Egypt.
authors.forename: Kamal
authors.initials: K
authors.lastname: El-Gafary
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D015641:Radiography, Interventional; D016896:Treatment Outcome
keywords: Acetabular fracture; Fracture reduction; Lag screw; Limited open reduction; Mini-open reduction; Minimal invasive; Para-rectus approach; Percutaneous fixation; Surgical approach