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Comparison of Acetabular Fracture Reduction Quality by the Ilioinguinal or the Anterior Intrapelvic (Modified Rives–Stoppa) Surgical Approaches

Shazar, Nachshon MD*,†; Eshed, Iris MD†,‡; Ackshota, Nissim MD*; Hershkovich, Oded MD, MHA*; Khazanov, Alexander MD§; Herman, Amir MD, PhD*,†,‖

Journal of Orthopaedic Trauma: June 2014 - Volume 28 - Issue 6 - p 313–319
doi: 10.1097/01.bot.0000435627.56658.53
Original Article

Objective: To compare the reduction quality, surgery time, and early postoperative complications between the 2 following surgical approaches: the ilioinguinal and the anterior intrapelvic (AIP or modified Rives–Stoppa).

Design: Retrospective study.

Patients: Comparison of 122 patients operated in our center between 1996 and 2003 with the ilioinguinal approach and 103 cases operated between 2004 and 2011 with the AIP approach.

Setting: Level 1 trauma center, acetabular fracture surgery referral center.

Outcome Measurement: The patients' demographics, fracture type, fracture reduction quality, surgery time, and postoperative complications were compared.

Results: Anatomic reduction was achieved in 84 patients (68.9%) treated by the ilioinguinal approach and in 85 patients (82.5%) treated by the AIP approach (P = 0.018). In both the columns, acetabular fracture type anatomic reduction was achieved in 54.2% of the ilioinguinal group and 79.4% of the AIP group (P = 0.018). In the ilioinguinal group, surgery time decreased as the number of surgeries increased (P = 0.021), whereas a similar trend was not found in the AIP group. Fracture type distribution and complication rates were similar for both the groups.

Conclusions: The AIP approach is a safe alternative that offers better exposure and possibly improved reduction quality of acetabular fractures compared with the ilioinguinal approach. We believe that the major advantage of the AIP approach is that it enables reduction of the posterior column and the quadrilateral plate from the contralateral side and enables application of a buttress plate below the pelvic brim.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel;

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;

Departments of Imaging and

§Anesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel; and

Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Reprints: Amir Herman, MD, PhD, Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel (e-mail: amirherm@gmail.com).

Presented in part as a poster presentation at the Annual Meeting of the Orthopaedic Trauma Association, October 2012, Minneapolis, MN.

The authors report no funding or conflict of interest.

Accepted September 05, 2013

© 2014 by Lippincott Williams & Wilkins