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Selecting Surgical Approaches for Treatment of Acetabular Fractures

Cheng, Edward Y., MD; Editor, JBJS Essential Surgical Techniques; Bastian, Johannes D., MD; Editor, Series on Pelvic Approaches for Acetabular Fractures

JBJS Essential Surgical Techniques: March 26, 2019 - Volume 9 - Issue 1 - p e4
doi: 10.2106/JBJS.ST.18.00102
Editorial
Supplementary Content
Disclosures

Acetabular fractures are among the most challenging fractures to treat. The complex anatomy of the pelvis with its array of critical structures, such as major nerves, vessels, and adjacent viscera, greatly impedes access to and visualization of the acetabulum. Evidence has shown that the functional outcome of acetabular fracture care depends, in large part, on anatomic surgical reduction and stable fixation. Functional outcomes have no doubt greatly improved as a result of improvements in surgical exposure, implant design, and perioperative care. However, with the increase in the geriatric population and associated acetabular fractures, which have specific anatomical characteristics, the acetabular fracture morphology seen by today’s surgeons is evolving.

Newer established surgical exposures of the pelvis have allowed great strides in attaining the goal of sufficient access to the fractured acetabulum to perform the required reduction. JBJS Essential Surgical Techniques (EST) is excited to present a digital collection of technique articles on this topic, authored by notable authorities in this field from the Universities of Bern and Leeds and taking advantage of the EST multimedia platform.

Rather than focusing on the type of acetabular fracture according to a specific classification, these articles describe surgical approaches that can be used to access specific portions of the osseous pelvis as required for optimal reduction and for the type of planned fixation (see Appendix). The approaches are divided according to the anterior and posterior columns. On the anterior side, the traditional ilioinguinal approach is described by the Leeds group and the newer Stoppa and pararectus approaches, by the Bernese group. On the posterior side, the workhorse (Kocher-Langenbeck) approach is shown by the Leeds group and then compared with the use of surgical hip dislocation as illustrated by the Bernese group.

We invite you to view these articles, refresh your knowledge base of the well-established approaches, and then challenge yourself as you peruse newer techniques. We hope that this collection of articles will add to your surgical armamentarium by describing the newer approaches in a manner that is readily understandable through the platform that JBJS EST provides.

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Appendix

An interactive, 3-dimensional (3D) pelvic figure is available with the online version of this article as a data supplement at jbjs.org (http://links.lww.com/JBJSEST/A236). To view, manipulate, and rotate the image, download and open the file using Adobe Acrobat or Reader and enable it (click on “options” and “trust this document”; note that this will not work if the file is opened in a web browser).

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A235).

Supplemental Digital Content

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Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated