In a 9-year period, 61 patients with acetabular fractures were treated with a stabilization through an ilioinguinal approach. 27 fractures were classified as. The ilioinguinal approach is primarily an approach to the anterior column and inner aspect of the innominate bone. The entire internal iliac fossa as well as the pelvic brim are exposed. The uadrilateral surface is also visualized through this approach. The modified Stoppa approach was introduced to manage fracture of the anterior column instead of the ilioinguinal approach to reduce morbidity. However there.
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Pelvic and acetabular surgical exposure
The complication rate ilioinguinal approach low in the modified group but not significantly different between the ilioinguinal approach groups. Forty-two patients were followed up with clinical examination and radiographs at a mean of Solid union was observed in 42 cases at a mean time of The mean Harris Hip Score and the Majeed scores at the time of evaluation were not significantly different between the 2 groups.
On comparing the 2 surgical ilioinguinal approaches, it was found that using modified ilioinguinal approach decreased operative time and blood loss, and did not affect the ilioinguinal approach of fracture reduction and fracture healing.
This study demonstrates that the modified ilioinguinal approach is a simple and minimally invasive approach for anterior column acetabular fractures and pubic rami fractures comparing with the standard ilioinguinal approach. The surgical decision making entails classification of the fractures and operative approach.
The choice of operative ilioinguinal approach is dependent on the fracture type, direction of displacement, skin situation at the surgical incision site, and duration from initial injury.
The main complications comprise high rates of postoperative wound infections and iatrogenic injury to the femoral nerve and the iliofemoral blood vessels.
The lateral femoral cutaneous nerve passes through or immediately deep to the inguinal ligament. The nerve usually passes immediately adjacent to the anterior superior iliac spine but can be found at variable locations.
The nerve should be identified and mobilized prior to detachment of the inguinal ligament from the ASIS. The iliopectineal fascia must be released to provide exposure to the second window of the approach.
This fascia separates the femoral nerve from the external iliac artery and vein. Retracting iliopsoas and femoral nerve laterally and the external iliac vessels medially provides exposure to the iliopectineal fascia so that ilioinguinal approach can ilioinguinal approach incised under direct vision to the iliopectineal eminence.
Blunt finger dissection can be used to further elevate the iliopectineal fascia off of the pelvic brim. A penrose drain can be placed around the iliopsoas muscle, femoral nerve, and lateral femoral cutaneous nerve.
Hip and knee flexion can be used to relax the iliopsoas tendon if further exposure is needed. A second penrose is passed from the middle window to the midline opening of the linea albae containing the external iliac vessels, contents of the inguinal canal medial to the iliopsoas, and the affected side rectus abdominus.
Exposure extension To fully develop the medial Stoppa window, stand on the opposite side of the table to visualize the medial wall of the acetabulum.
A headlight improves visualization inside the pelvis. Dissection can be continued underneath the neurovascular structures external iliac vessels to the level of the sacroiliac joint.
Wheeless' Textbook of Orthopaedics
A blunt Hohmann or malleable retractor can be placed against the ischial spine. In this video, we demonstrate anatomical reconstruction of the acetabulum in a patient with ilioinguinal approach associated both-column fracture using the ilioinguinal approach.
Indications are all acetabular fracture types, where in addition to ilioinguinal approach column fracture, a fractured posterior column is reducible through the middle window, that is, there is no involvement of the posterior column or wall that would necessitate ilioinguinal approach direct posterior approach.