Two-Incision Minimally Invasive Approach for the Treatment of Anterior Column Acetabular Fractures

INTRODUCTION: We describe an alternative to the Letournel ilioinguinal approach for anterior column acetabular fractures that is performed with a unique retraction device that decreases the rate of soft-tissue complications. STEP 1: POSITION THE PATIENT AND IDENTIFY THE SITES FOR THE INCISIONS: Identify the sites for both incisions with the help of an image intensifier. STEP 2: MAKE THE FIRST INCISION TO EXPOSE THE ANTERIOR COLUMN AND THE LINEA TERMINALIS (PELVIC BRIM): Make the first incision to expose the central area of the fracture. STEP 3: MAKE THE SECOND INCISION TO EXPOSE THE SYMPHYSIS AND THE IPSILATERAL PUBIC BONE: Make the second incision to expose the area for the distal plate fixation. STEP 4: MAINTAIN EXPOSURE OF THE LINEA TERMINALIS USING A SOFT-TISSUE RETRACTION SYSTEM: For better visualization, use a soft-tissue retraction system. STEP 5: REDUCE THE FRACTURE: Clean and reduce the fracture through the first incision. STEP 6: FIX THE FRACTURE: Perform temporary and definitive fixation according to the standards for anterior acetabular fracture fixation. STEP 7: CLOSE THE WOUND: After radiographic documentation in three views, close the wound. RESULTS: We reported the results of a case-control study of the first twenty-six patients operated on with the two-incision minimally invasive technique. Indications Contraindications Pitfalls & Challenges