Modified Ollier transtrochanteric approach for the treatment of acetabular fractures

The purpose of this retrospective clinical study was to evaluate the rates of wound and neurologic complications and clinically significant heterotopic ossification, Brooker stage 3 and 4, with the modified Ollier transtrochanteric approach for the treatment of acetabular fractures. The study group comprised 94 consecutive patients (95 acetabuli) who had unstable acetabular fractures requiring surgical fixation. All patients were treated with open reduction internal fixation via the Ollier approach by a single surgeon (L.E.D.). Demographic and clinical information regarding rates of wound and neurologic complications and remaining articular stepoff at fixation was obtained from a chart review. The degree of heterotopic ossification was graded from standard anteroposterior pelvis radiographs according to the Brooker classification. Six (6%) patients underwent reoperation for infection; however, only 3 (3%) of these patients had deep infections. Three (3%) patients had iatrogenic sciatic nerve injuries; only 1 patient had persistent sensory changes at final follow-up. Thirteen (18%) of the 73 patients with radiographs available for review at a minimum of 3-month follow-up had Brooker grade III heterotopic ossification and 1 (1%) patient had grade IV. Five (5%) patients underwent excision of heterotopic ossification. Fourteen (17%) of 81 patients had no radiographic union of the greater trochanteric osteotomy, but none of these patients required further surgery. The complication rates of the Ollier approach in this study compare favorably with alternative surgical approaches reported in large series. We believe this approach provides excellent exposure without increasing the risk of complications.