Corona Mortis血管解剖学研究及其临床意义

目的:探讨闭孔血管和髂外血管在腹股沟区的分支,为减少髂腹股沟入路术中出血提供解剖学基础。方法:对25具新鲜中国成人尸体标本共50侧半骨盆进行解剖学研究,观测闭孔血管和髂外血管在腹股沟区的分支及其吻合支(CoronaMortis血管)的大小、出现率、吻合血管行径和吻合血管至耻骨联合的距离。结果:72%(36侧)耻骨上支表面至少存在1条血管吻合支,其中28%(14侧)存在2条或3条血管吻合支,24%(12侧)同时存在动脉吻合支和静脉吻合支。耻骨上支表面的血管吻合支平均直径2.6mm(2.0～4.2mm)。血管吻合支紧贴耻骨上支或髂耻隆起,几乎垂直地下行于髋臼窝壁或耻骨支后方,经闭膜管出盆腔,血管吻合支与耻骨联合的平均距离52mm(38～68mm)。在此区域手术以及髋臼或骨盆前环骨折极易损伤CoronaMortis血管。结论:闭孔血管和髂外血管的吻合支较粗,出现率高,位于耻骨上支表面。髂腹股沟手术入路应特别注意CoronaMortis血管的存在。     

改良Stoppa入路死亡冠血管的解剖学研究

目的研究改良Stoppa入路髂外和腹壁下血管与闭孔血管在耻骨上支区的吻合支（死亡冠）解剖学特点,为提高骨盆髋臼前路手术操作安全性提供解剖学基础。方法模拟改良Stoppa入路对12具国人成人尸体标本共24侧半骨盆进行解剖学研究。观测死亡冠血管的出现率、直径大小、长度及其至耻骨联合和髂耻隆起的距离。结果87．5％（21侧）耻骨上支表面存在死亡冠血管,其中62．5％（15侧）为静脉型,8．3％（2侧）为动脉型,16．7％（4侧）为混合动静脉型。死亡冠血管的长度平均32．1（24．1～40．6）mm,直径平均2．5（2．0～3．7）mm。死亡冠血管至耻骨联合距离平均54．9（47．8～63．8）mm,至髂耻隆起距离平均20.3（6．2～35．0）mm。死亡冠血管紧贴耻骨上支,移动度小。结论死亡冠血管出现率高,变异度大,以静脉型为主。移位骨盆前环髋臼骨折及前入路手术时易损伤死亡冠血管,应注意其存在并妥善处理,推荐骨膜下剥离。     

A new concept and classification of corona mortis and its clinical significance

Purpose: The obturator artery and its accessory (aberrant) arising from different origins and crossing the pubic rami are vascular variations. The internal iliac artery usually provides the obturator artery which may communicates with the external iliac artery through either the accessory obturator or inferior epigastric artery. A collateral circulation between the external and internal iliac system is known as corona mortis. The aim of current study is to provide sufficient data of vascular variability crossing the pubic rami for clinical field. Methods: Present study includes 208 hemipelvises dissected in the Institution of Anatomy, Medical University of Graz. During dissection, the obturator artery and its accessory crossing the superior rami of pubic bone were found to have different origins. Results: The obturator artery arising from the external iliac artery and from the femoral artery accounts for 9.8% and 1.1% respectively. Therefore, it passes over the superior pubic rami in 10.9%. Further, the accessory (aberrant) artery arises only from the femoral artery in 1.1%. In present study, the vascular variation crossing the superior pubic rami with or without collateral circulation between external and internal iliac system referred as corona mortis is addressed. This study includes new classification of obturator and accessory obturator arteries as well as the corona mortis. It includes a comparison of corona mortis incidence in Austria population and other populations. The corona mortis found to be in 12% of Austrian population. Conclusion: A great attention of clinicians, radiologists, surgeons, orthopedic surgeons, obstetricians and gynecologists has to be considered before pubic surgical procedures such as internal fixation of pubic fracture, an inguinal hernia repair. Further, traumatic pubic rami fracture may lead to massive hemorrhage due to laceration of the obturator artery.     

A serious bleeding complication with injury of the corona mortis with the TVT-Secur procedure

We report a serious complication following a TVT-Secur procedure due to injury of the corona mortis requiring a surgical intervention for removal of 1 l of clotted blood from the space of Retzius. The corona mortis is an anomaly of the vessel combining the obturator and epigastric arteries passing over the superior pubic ramus, well known to hernia and orthopedic surgeons but probably less well known to gynecological surgeons.     

The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery

PurposeCorona mortis is a highly variable vascular connection between the obturator and external iliac or inferior epigastric arteries or veins located behind the superior pubic ramus in the retropubic space (space of Retzius). Due to the significant variation in this collateral circulation, detailed anatomical knowledge of the corona mortis is vital to enhance the prevention of possible iatrogenic errors in hernia repair and other pubic surgical procedures. The aim of our meta-analysis was to provide comprehensive data on the prevalence, anatomical characteristics, and ethnic variations of the corona mortis vessel.MethodsAn extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included investigative method, prevalence of the corona mortis vessels among hemi-pelvises (overall, arterial only, venous only, and combined), distance from the corona mortis to pubic symphysis, and assessment of gender, side, laterality, and ethnicity subgroups.ResultsA total of 21 studies (n = 2184 hemi-pelvises) were included in the meta-analysis. The overall prevalence of the corona mortis in hemi-pelvises is high (49.3%). A venous corona mortis is more prevalent than an arterial corona mortis (41.7% vs. 17.0%). The corona mortis is more common in Asia (59.3%) than in Europe (42.8%) and North America (44.3%).ConclusionsAs a corona mortis is present in an about half of all hemi-pelvises, it is important to consider the possibilities of its presence when undertaking surgical procedures and plan accordingly to avoid injuries. All surgeons operating in the retropubic region should have a thorough understanding of the anatomical characteristics and surgical implications of a corona mortis.     

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??Applied anatomical studying on corona mortis in Chinese ZHOU Lu-ke??ZHAO Yu??SUN Shan-quan, et al. Department of Vascular Surgery??the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Corresponding author: ZHAO Yu, E-mail: zhaoyu@cta.cq.cn
Abstract Objective To observe the incidence and adjacent to the corona mortis, so as to provide anatomic basis for the surgical of ilioinguinal approach. Methods One hundred and two hemipelvises were assessed in 51 embalmed cadavers??37 males and 14 females??between November 2011 and February 2012 in the First Affiliated Hospital of Chongqing Medical University. Bilateral dissection was performed in every case with a total of 102 sides. The relationship between the corona mortis and external iliac vessels system was indentified and the distance from the corona mortis to the symphysis pubis was measured. Results Fifty-one human adult cadavers were dissected bilaterally (102 hemipelvises), with evidences of the vascular elements at the level of the superior pubic branch in 39 cases (66 sides, 76.5%) of hemipelvises. Among them, the average of distance from the corona mortis to the symphysis pubis was (52.00±12.29) mm in male and (55.39±11.86) mm in female. There was no significant difference in the incidence and distance from communicating vessels to the symphysis pubis between male and female??P??0.05??. Conclusion The incidence of an anomalous obturator artery forming the arterial corona mortis among Chinese is 76.5%. The corona mortis crossing over the iliopubic rami should be taken attention during the ilioinguinal surgery.     

The incidence and location of corona mortis: a study on 75 cadavers

We dissected 150 fresh cadaver halves by ilioinguinal exposure, and counted all vessels more than 2 mm in diameter, connecting the obturator system to the external iliac system. The distance between the symphysis pubis and the anastomotic vessels was measured. We found vascular anastomoses between the obturator and external iliac systems in 91 of 150 sides (61%), and anastomotic veins in 78 of 150 exposures (52%). Arterial connections were seen in 29 of the exposures (19%). The mean distance between the anastomotic arteries and the symphysis pubis was 64 (45-90) mm, and 56 (37-80) mm for the communicating veins. There seemed to be no significant difference between genders in the incidence of corona mortis and the distance between communicating vessels and the symphysis pubis.     

Vascular anatomy for rotational acetabular osteotomy: cadaveric study

 Rotational acetabular osteotomies are performed to correct dysplastic hips in young adults. However, there is a potential risk of intrapelvic vascular injury. To define the relation of these vascular structures to the bone around the acetabulum, we measured the distance and direction from the anteroinferior iliac spine to the external iliac artery and from the base of the superior pubic ramus to the obturator artery in 34 cadaveric hemipelves (17 male, 17 female; 19 left, 15 right). The distance to the external iliac artery was significantly shorter in females (average 31.7 mm) than in males (average 38.2 mm); and the distance to the intrapelvic entry portal of the obturator canal, through which the obturator artery passes, was significantly shorter in females (average 27.2 mm) than in males (average 33.4 mm). In addition, the external iliac artery was located significantly more ventral and closer to the anteroinferior iliac spine in right hemipelves than in left hemipelves. The intrapelvic entry portal of the obturator canal was located more caudodorsal to the base of the superior pubic ramus in females than in males. Care should thus be taken during surgery in light of our findings. Received: May 17, 2002 / Accepted: December 12, 2002 RID="*"     

A South Indian cadaveric study on obturator neurovascular bundle with a special emphasis on high prevalence of ‘venous corona mortis’

Surgical procedures in the pelvic region are very challenging because of the complex anatomy of this region. “Corona mortis” is a term used to describe retro-pubic anastomosis between the obturator and external iliac vessels. It is considered as a key structure as significant haemorrhage may occur if the vessels are cut accidentally during pelvic surgeries. Earlier studies have documented a high frequency of venous anastomosis compared to its arterial counterpart. The objective of our study was to document the prevalence of venous corona mortis in South Indian human adult cadaveric pelvises. We conducted this study on 73 cadaveric pelvic halves. Out of the 73 hemi pelvises, 36 were normal without any variations of the obturator vessels while 37 hemi pelvises (51%) showed the presence of abnormal obturator vessels which proves to be a very high incidence in terms of variations. Out of the 37 hemi pelvises, 25 (68%) showed the presence of 2 obturator veins, out of which 1 was normal and the other was an abnormal obturator vein. 8 hemi pelvises (22%) had only abnormal obturator vein. Most of the abnormal obturator veins drained into the external iliac vein, while two veins drained into inferior epigastric veins. Venous corona mortis is said to be frequently encountered during surgery and is considered to be as important as arterial corona mortis in its clinical implications. Individual evaluation of this risky anatomical structure should be done prior to any surgical interventions.     

A prospective endoscopic study of retropubic vascular anatomy in 121 patients undergoing endoscopic extraperitoneal inguinal hernioplasty

Background: A sound knowledge of retropubic pelvic vascular anatomy is pivotal to the successful performance of endoscopic total extraperitoneal (TEP) inguinal hernioplasty. The objective of the current study was to evaluate the incidence and anatomy of iliopubic and aberrant obturator vessels. Methods: Between July 2001 and March 2002, a prospective endoscopic evaluation of retropubic vascular anatomy was performed on patients who underwent TEP. Endoscopic photographs of the vasculature overlying the superior pubic ramus in the recruited patients were captured on a computer. Results: The retropubic vascular anatomy of 121 patients, who underwent either unilateral (n = 100) or bilateral (n = 21) TEP was examined. The iliopubic artery and vein were invariably present in every patient, and traversed along the iliopubic tract toward the pubic symphysis. The aberrant obturator artery was present in 31 pelvic halves, giving an overall incidence of 22%. The aberrant obturator vein existed between the external iliac and obturator venous system in 27% (n = 38) of the 141 pelvic halves examined. The overall incidence of corona mortis, in the form of either an aberrant obturator vein or artery, was 40% (n = 56). Conclusions: Iliopubic vein and artery are universal findings in every patient. Both aberrant obturator artery and vein cross the superior pubic rami, and are therefore susceptible to injuries during dissection of the Bogros space and stapling of the mesh onto Coopers ligament. Awareness of these aberrant vessels will help to reduce bleeding and subsequent morbidity. Tracing along the aberrant vessel can easily identify the obturator foramen, which is an anatomic landmark that indicates an adequate inferior dissection of the preperitoneal space. The abstract has been submitted to the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) 2003 for consideration of presentation     

Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair

Purpose

Corona mortis (CMOR) is the arterial and/or venous vascular communication(s) between the obturator and external iliac vessels. Totally extraperitoneal (TEP) inguinal hernioplasty can be associated with vascular complications especially during the fixation of the mesh. Theoretically, CMOR is an important nominee. But, the data in literature are insufficient about CMOR injury. Additionally, most of the studies about CMOR have been usually performed on cadavers. We aimed to reveal the preperitoneal vascular anatomy of inguinal area and provide in vivo knowledge about CMOR. The risk of arterial injury was also evaluated.

Materials

The data of preperitoneal vascular anatomy of 321 patients who underwent TEP procedure between January 2005 and July 2014 were retrospectively evaluated.

Results

Mean age was 46 ± 8.9 years, 53 females vs 268 males. 391 hemipelvises were evaluated. Two types of arterial structure were identified; (1) an aberrant obturator artery forming an anastomosis with branches of ordinary obturator artery; (2) a pubic branch of inferior epigastric artery. The incidence of arterial CMOR was 28.4 % and of any arterial structure was 45.0 %. An arterial CMOR was considered as thick (≥2 mm) or thin (<2 mm). Injury of arterial CMOR during tack stapling on Cooper’s ligament was seen in six cases (1.5 %). All of them were thin (<2 mm) in structure. Venous CMOR was visible only under low pressure in work space.

Conclusion

During TEP hernia repair, CMOR and/or pubic branch of inferior epigastric artery can be damaged. To prevent this complication, tacks should be stapled to Cooper’s ligament close to symphysis pubis and dissection should be careful on the posterior surface of superior pubic ramus. Small caliber (<2 mm) arterial CMOR is more prone to be injured during TEP procedure. To explore venous structures properly, pressure in workspace should be kept as low as possible.

     

髂腹股沟微创小切口内固定治疗髋臼前柱或耻骨支骨折

 目的 探讨经髂腹股沟微创小切口内固定治疗髋臼前柱或耻骨支骨折的临床效果。 方法 2008 年6 月至2011 年6 月, 对16 例髋臼前柱骨折、10 例耻骨支骨折患者采用髂腹股沟微创小切口内 固定治疗。所有患者均采用全麻, 于髂结节至髂前上棘做3~5 cm 斜行切口, 沿髂骨内侧骨膜下剥离至 髂前下棘、髂耻隆起、髋臼前柱, 再于耻骨结节向外2~3 cm 横行切口, 沿耻骨支前上方骨膜下剥离显露 耻骨支, 两个切口分别向中间潜行剥离后形成沿耻骨支髋臼前柱相贯通的骨膜下隧道, 复位骨折, 将重 建钛板预弯后导入隧道, 固定骨折。 结果 根据Matta标准, 术后解剖复位13 例, 复位良好11 例, 复位 较差2 例。23 例患者获得平均15.6 个月随访(6~30 个月)。髋关节功能按照D’Aubigne 评分:优13 例, 良6 例, 可4 例。骨盆功能按照Majeed评分:优12例, 良9 例, 可2 例。无感染、股神经或股血管损伤、静 脉血栓、异位骨化等并发症发生。 结论 经髂腹股沟微创小切口内固定治疗髋臼前柱或耻骨支骨折创 伤小, 手术时间短, 安全性相对较高。髂耻前柱放置钢板对钢板塑形的要求低, 固定可靠。     

Corona mortis exposition during laparoscopic procedure for gynecological malignancies

Corona mortis (CMOR) is an anastomotic branch between the external iliac or inferior epigastric vessels and the obturator artery or vein, or any vascular connection between the obturator and the external iliac systems in general with high anatomic variability. The aim of this study was to evaluate the type of anastomosis, if arterial, venous or both and the other subtypes of CMOR. Twenty-five laparoscopic procedures of bilateral pelvic lymphadenectomy for gynecological oncologic procedures (50 half pelvises) were performed. CMOR was located in 15 half pelvises on the right side (60 %), in 7 half pelvises on the left side (28 %), in 3 patients it was evidenced bilaterally. CMOR was dissected in 26/50 (52 %) half pelvises. Venous anastomosis was more frequently (46 %) followed by both venous and arterial vessels; in only 8 % (2/26) an arterial communication was observed. 83 % of venous anastomosis were single communications. One isolated arterial anastomosis was evidenced in two patients. In the cases of both arterial and venous anastomosis, one venous and one arterial vessel in 5/6 (83 %) were detected, and one type of anastomosis with one arterial and two venous vessels. Our data suggest that venous CMOR is usually present in higher frequency than the arterial one, followed by the combined type with arterial and venous connections. The isolated venous anastomosis resulted the frequent subtype.     

骨盆创伤知名血管损伤的紧急处理策略

目的 探讨骨盆创伤中骨盆知名血管损伤时的紧急处理策略。方法 回顾性分析2005年1月至2021年10月山东省立医院收治的58例骨盆知名血管损伤病人的临床资料，其中男36例，女22例，年龄为（47.9±14.8）岁（24~75岁）。其中“死亡冠”血管损伤15例（医源性损伤8例）；臀上动静脉损伤17例（医源性损伤7例）；臀下动静脉损伤6例（医源性损伤1例）；阴部内动脉损伤13例；髂外动静脉（股动静脉）损伤7例（医源性损伤3例）。所有病人根据不同的血管损伤机制，术中根据不同的情况分别选择直接血管结扎、纱布填塞、血管造影栓塞或联合腹主动脉阻断等方法急救止血。结果 58例骨盆知名血管损伤的病人，其中有55例病人得到成功的处理，术后存活。其中2例因“死亡冠”血管损伤所致的大出血死亡，1例因臀上动脉医源性损伤所致的大出血死亡。结论 临床医生在面对骨盆及臀部创伤时要充分了解并掌握骨盆知名血管损伤的预防和处理，同时也不能忽视骨盆知名血管的潜在损伤。了解骨盆骨折类型与血管损伤的潜在联系，对于“死亡冠”血管，可行预防性结扎避免损伤，一旦损伤在无法结扎的情况下应纱布填塞压迫止血结合介入栓塞；对于臀上和臀下血管，造影栓塞可作为第一选择，必要时可联合腹主动脉球囊阻断；对于阴部内动脉，纱布填塞及造影栓塞均有较好的效果；对于髂外血管的损伤，可在腹主动脉球囊阻断下行血管修补或置换。当骨盆知名血管损伤时，根据具体情况，掌握止血急救的措施，根据自已医院条件和自身的经验选择合适的方法，提高病人的预后和生存率。     

Obturator Oblique and Pubic Ramus Inlet Views Can Better Guide the Insertion of an Anterior Column Acetabular Screw

ObjectiveThe objective of the present paper was to investigate the value of obturator oblique and pubic ramus inlet views in guiding anterior column acetabular screw insertion.MethodsWe collected pelvic CT scans at the diagnostic imaging center of our hospital between 2017 and 2019. Virtual three‐dimensional (3D) models of the pelvis were created based on the CT scans. Then the transparency was adjusted to 30%. Two identical copies of the 3D model data were made. 3D model replications were divided into a control group and an experimental group. In the control group, the screw was inserted into the anterior acetabular column using obturator‐outlet and iliac‐inlet views. In the experimental group, the screw was guided under obturator oblique and pubic ramus inlet views. Based on whether the screw penetrated the hip joint and/or exited the pubic ramus, models were divided into three grades. Grade I: the screw travels completely within the anterior column bone corridor; Grade II: the screw exits the superior pubic ramus, but the length of the screw outside the channel does not exceed 1/2 of the anterior column; Grade III: the screw exits the superior pubic ramus and the length of the screw outside the corridor exceeds 1/2 of the anterior column. We compared the screw placement quality of the two groups and analyzed differences between genders. In addition, the distance between the screws and the acetabulum was recorded and compared among the two groups.ResultsA total of 110 hemipelves were selected, including those of 80 men and 30 women, with an average age of 46.76 ± 14.26 years. In the control group, the screw quality of 64 models (58.2%) was Grade I. In the experimental group, 94 models (85.5%) had Grade I screw placement quality. Grade II screw placement quality accounted for 18.2% of the control group and 7.3% of the experimental group. In the control and the experimental groups, there were 26 and 8 cases with Grade III screw placement quality, respectively. The quality of screw placement in the experimental group was significantly better than that in control group, and the difference between the two groups was statistically significant (P < 0.01). The distance between the screw and the acetabulum in the control group and experimental group was 0.92 ± 0.49 mm and 2.78 ± 1.15 mm, respectively. The difference between the two groups was statistically significant.ConclusionAnterior column acetabular screws can be inserted successfully and more accurately using the obturator oblique and pubic ramus inlet views.     

Pubic tubercle side approach to the obturator nerve block

BACKGROUND: The authors describe the pubic tubercle side approach of the obturator nerve block for the management of adductor muscle constriction associated with the transurethral resection of the lateral wall bladder tumor. METHODS: The pubic tubercle side approach of the obturator nerve block was performed by a inserting needle at the midpoint of the femoral artery and the pubic tubercle. After the needle encountered the superior ramus of pubis, the needle was redirected vertical or slightly caudal, passeing the vicinity of the inferior margin of the superior ramus of pubis, and then advanced to the trunk of the obturator nerve. The obturator nerve was identified by its response to nerve stimulation. The pubic tubercle side approach using more than 5 ml of 1.0% lidocaine was performed by a single injection until there was no response to nerve stimulation. On the other hand, by the traditional approach to the obturator nerve block, after the initial local anesthetic injection the needle was redirected lateral and slightly caudal. If the response to nerve stimulation was still elicited, more local anesthetic was administered. RESULTS: Evaluation of the efficacy of the pubic tubercle side approach was performed in-terms of quantity of the local anesthetic used and the success rate. In comparison with the traditional approach, a smaller dose of local anesthetic was used in spite of the higher success rate. CONCLUSIONS: The pubic tubercle side approach of the obturator nerve was useful and without complications in comparison with the traditional approach.     

Location of intrapelvic vessels around the acetabulum assessed by three-dimensional computed tomographic angiography: prevention of vascular-related complications in total hip arthroplasty

BackgroundDuring total hip arthroplasty (THA), the external iliac, femoral, and obturator vessels are at risk of vascular injury when penetrating the inner cortex of the pelvis. The purpose of this study was to clarify the location of these vessels using three-dimensional computed tomographic angiography (3DCT-A).MethodsWe enrolled 100 subjects (200 hips) without hip disease and performed examinations on the following. (1) External iliac–femoral vessels: we measured the shortest distance from these vessels to the pelvis on axial CT images and investigated the factors affecting distance. The anatomical course of the iliac artery was classified as straight, curved, or tortuous, and the correlation between course and age was established. (2) Obturator vessels: we measured the shortest distance from the obturator vessels to the quadrilateral surface on axial CT images. (3) Visualization of pelvic vessels was through the pelvis by dual-phase 3DCT-A.Results(1) The external iliac vein was located significantly closer to the pelvis than the artery, especially on the left side and in aged and female subjects. The single-curved and tortuous double-curved vessel types were found in aged subjects, and external iliac vessels of these types were closer to the pelvis than vessels of the straight type. In 36 subjects, the external iliac veins lay directly on the osseous surface of the pelvis (right 16, left 36). Of these 36 subjects, only one had straight-type vessels. (2) Obturator vessels were located just behind the acetabulum near the obturator foramen. (3) Reconstructed 3DCT images enabled us to visualize the pelvic vessels and demonstrated the danger area for penetrating the inner cortex of the pelvis.ConclusionUnderstanding the anatomical orientation of the pelvic vessels around the acetabulum using 3DCT-A could be helpful for preventing vascular injury during THA.     

Abdominoinguinal incision in resection of pelvic tumors with lateral fixation.

Large tumors in the area of the iliac fossa, external iliac vessels, wall of the lesser pelvis, and pubic bone are often considered unresectable through conventional abdominal incisions due to the lack of exposure, or they are managed with hindquarter amputation. The abdominoinguinal incision provides the necessary exposure for en-bloc resection of many of these tumors. It involves a lower midline incision that is extended transversely to the mid-inguinal point on the side of involvement and then vertically, over the course of the femoral vessels, which are exposed. The rectus abdominis is divided off the pubic crest and the inguinal ligament off the pubic tubercle, and the inferior epigastric vessels are ligated and divided at their origin. This allows in-continuity exposure of the lower abdomen, pelvis, and the groin in one field and dramatically improves the exposure.     

Combined Anterior Pelvic (CAP) approach for fracture acetabulum fixation - Functional outcome evaluation and predictors of outcome

ObjectiveIlio-inguinal approach has been considered standard anterior approach for acetabulum fracture fixation. Different modifications of this approach have been described. This study analysed the patients treated using a Combined Anterior Pelvic (CAP) approach - minimal AIP (anterior intra-pelvic) with modified ilio-femoral along with ’anterior superior iliac spine’ osteotomy. This combined approach provides wide exposure of pelvis to direct visualise the entire anterior column from sacroiliac joint to pubic symphysis, medial side of quadrilateral plate and entire iliac wing with minimal retraction of soft tissues required.MethodsData of patients treated from July 2014 to June 2018 for acetabulum fracture using CAP approach was retrieved from hospital record system. Inclusion criteria were - acetabulum fractures treated surgically using CAP approach. Exclusion criteria were – age less than 18 years, associated pelvis ring injury and incomplete peri-operative radiological record (pre-operative/post-operative antero-posterior, 45° obturator and 45° iliac oblique radiographs and pre-operative computed tomographic (CT) scans. 62 patients who met inclusion exclusion criteria were called in out-patient-department for final functional evaluation using Matta modified Merle d’aubigne score.ResultsOut of 62 patients 47 patients who turned up for final functional evaluation were included in study. 19 patients had excellent, 15 had good, 2 had fair and 11 had poor results. Age less than 40 years, anterior column fracture pattern, Pre-operative fracture displacement >20 mm, fracture comminution and post-operative fracture reduction within 3 mm were the predictors of the functional outcome. When analysed using logistic regression model, post-operative fracture reduction was found to be the only significant predictor of functional outcome.ConclusionCAP approach is useful anterior approach to acetabulum. Fracture reduction is the independent predictor of functional outcome. Comparison of this approach with other anterior approaches to acetabulum can be area of further research.