title: [Pararectus approach for treatment of acetabular both-column fracture combined with translocation of quadrilateral surface].
abstract: OBJECTIVE
  To study the clinical effect and surgical operating points of pararectus approach for the internal fixation of acetabular both-column fractures with concurrent displaced quadrilateral plate fractures.
  
  
  METHODS
  From January 2012 to December 2013, in the Third Affiliated Hospital of Southern Medical University, 15 patients with acetabular both-column fractures and displaced quadrilateral plate fractures were surgically managed through the pararectus approach. There were 11 male and 4 female patients, with an average age of 40 years (from 19 to 61 years). According to Judet-Letournel classification, there were 9 anterior column plus posterior hemitransverse fractures, 6 both-column fractures, 8 cases involving the pelvic fracture. All these fractures were treated through the pararectus approach, in the horizontal position with general anesthesia. The pre-bended plate was placed in interior pelvic ring to fix the anterior wall, anterior column and quadrilateral plate in direct sight. Then, the posterior column was exposed and fixed with antegrade lag screw. Patients were followed up in 4 weeks, 12 weeks, 6 months, 1 year after the operation, and the anteroposterior radiograph of pelvis and the X-ray examination of the fractured hip was performed.
  
  
  RESULTS
  All the 15 cases underwent the operation successfully. Postoperative X-ray and CT exams showed excellent and good reduction of anterior column, posterior column and quadrilateral plate, with none surgical complication occurred. According to the Matta radiological evaluation postoperatively, reduction of acetabular fracture was rated as excellent in 9 cases, good in 3 cases and poor in 3 cases. The rate of excellent and good was 12/15. After 8 to 18 months' follow-up (median follow-up time was 14 months), all the patients gained bone union. According to the modified Merle D'Aubigne and Postel scoring system, 9 cases were excellent, 4 were good, and 2 were fair. The rate of excellent and good was 13/15.
  
  
  CONCLUSIONS
  Surgical management of acetabular fractures through the pararectus approach can provide adequate exposure of reducing and fixing both-column acetabular fractures with concurrent displaced quadrilateral plate fractures, which has a good effect in clinical application.
authors.affiliation: Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Academy of Othopedics, Guangdong Province, Guangzhou 510630, China.
authors.forename: Guang
authors.initials: G
authors.lastname: Xia
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Yang
authors.forename: Ran
authors.initials: R
authors.lastname: Xiong
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.forename: Yanqing
authors.initials: Y
authors.lastname: Shao
authors.forename: Guizhong
authors.initials: G
authors.lastname: Du
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Qiguang
authors.initials: Q
authors.lastname: Mai
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.affiliation: Email: fanscyi@sohu.com.
authors.forename: Shicai
authors.initials: S
authors.lastname: Fan
mesh_terms: D000077:Acetabulum / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000768:Anesthesia, General; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000473:pathology / Q000601:surgery; D011184:Postoperative Period; D016103:Spinal Fractures; D016896:Treatment Outcome; D055815:Young Adult