Der ilioinguinale Zugang bei Azetabulumfrakturen

Objective Exposure of the entire anterior column of the acetabulum and of the inner part of the posterior column. Indications Open reduction and internal fixation of fractures of the anterior wall and anterior column of the acetabulum and of fractures, which involve both columns, on the condition that the posterior column can be reduced indirectly. Contraindications Fractures of the posterior wall.Fractures of the posterior column.Factures which involve both columns where the posterior column has to be reduced directly.Fractures requiring a direct access to the acetabulum, e. g., with intraarticular fragments. Surgical Technique Exposure of the acetabular fracture through three surgical windows. First window situated between the iliopsoas and the iliac crest, second window between the inguinal vessels and the iliopsoas, third window betwen the spermatic cord and the inguinal vessels. Indirect reduction of the fracture. Orientation through anatomic landmarks and image intensifier. Fixation of fracture with lag screws (iliac crest) and a long curved plate placed on the iliopectineal line. Results In a 9-year period, 61 patients with acetabular fractures were treated with a stabilization through an ilioinguinal approach. 27 fractures were classified as “simple” and 34 as “combined”. Intraoperative complications related to the approach were four (6.6%) secondary motoric neurologic damages, one thrombosis of the external iliac artery, and a thrombosis of the iliac veins. One fourth of the patients had paresthesias in the area of the lateral femoral cutaneous nerve. Of 38 patients examined after an average of 23 months, 85.4% obtained an excellent or good result using Merle d'Aubigné &; Postel score.