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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2022

Open Access 01-12-2022 | Acetabular Fracture | Research

The Pararectus approach in acetabular fractures treatment: functional and radiologcial results

Authors: Guoming Liu, Jinli Chen, Chengzhi Liang, Chengdong Zhang, Xuwen Li, Yanling Hu

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

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Abstract

Background

The surgical treatment of complex acetabular fractures is one of the most challenging procedures for orthopedic surgeons. The Pararectus approach, as a reasonable alternative to the existing surgical procedures, was performed for the treatment of acetabular fractures involving the anterior column. This study aimed to evaluate outcome using the Pararectus approach for acetabular fractures involving anterior columns.

Methods

Thirty-seven with displaced acetabular fractures involving anterior columns were treated between July 2016 and October 2019 using the Pararectus approach. The functional outcomes (using the Merle d Aubigné and Postel scoring system, WOMAC and modified Harris scoring), the quality of surgical reduction (using the Matta criteria), and postoperative complications were assessed during approximately 26 months follow-up period.

Results

Thirty-seven patients (mean age 53 years, range: 30–71; 28 male) underwent surgery. Mean intraoperative blood loss was 840 ml (rang: 400–2000 ml) and mean operating time was 210 min (rang: 140–500 min). The modified Merle d Aubigné score was excellent and good in 27 cases (73%), fair in 6 cases (16%), and poor in 3 cases (11%). The mean score was 88.5 (range:77–96) for the modified Harris Hip scores, and 22 (range:7–35) for the WOMAC scores after operation. Postoperative functional outcomes were significantly improved compared with preoperative outcomes (P < 0.0001). The quality of reduction was anatomical in 21 cases (57%), satisfactory in 9 cases (24%), and unsatisfactory in 7 cases (19%). At follow-up, four patients developed a DVT, and heterotopic bone formation was observed in one patient. The hip osteoarthritis was not observed.

Conclusion

The Pararectus approach achieved good functional outcomes and anatomical reduction in the treatment of acetabular fractures involving anterior column with minimal access morbidity.
Literature
1.
Ferguson TA, Patel R, Bhandari M, Matta JM. Fractures of the acetabulum in patients aged 60 years and older: an epidemiological and radiological study. J Bone Joint Surg Br. 2010;92(2):250–7.CrossRefPubMed
2.
Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br Vol. 2005;87(1):2–9.CrossRef
3.
Anglen JO, Burd TA, Hendricks KJ, Harrison P. The “Gull Sign”: a harbinger of failure for internal fixation of geriatric acetabular fractures. J Orthop Trauma. 2003;17(9):625–34.CrossRefPubMed
4.
Judet R, Judet J, Letournel E. Fractures of the Acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am Vol. 1964;46:1615–46.CrossRef
5.
Gansslen A, Grechenig ST, Nerlich M, Muller M, Grechenig W. Standard Approaches to the Acetabulum Part 2: Ilioinguinal Approach. Acta Chir Orthop Traumatol Cech. 2016;83(4):217–22.PubMed
6.
Jakob M, Droeser R, Zobrist R, Messmer P, Regazzoni P. A less invasive anterior intrapelvic approach for the treatment of acetabular fractures and pelvic ring injuries. J Trauma. 2006;60(6):1364–70.CrossRefPubMed
7.
Shazar N, Eshed I, Ackshota N, Hershkovich O, Khazanov A, Herman A. Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified Rives-Stoppa) surgical approaches. J Orthop Trauma. 2014;28(6):313–9.CrossRefPubMed
8.
Rocca G, Spina M, Mazzi M. Anterior Combined Endopelvic (ACE) approach for the treatment of acetabular and pelvic ring fractures: A new proposal. Injury. 2014;45(Suppl 6):S9–15.CrossRefPubMed
9.
Keel MJ, Ecker TM, Cullmann JL, Bergmann M, Bonel HM, Buchler L, Siebenrock KA, Bastian JD. The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg Br. 2012;94(3):405–11.CrossRefPubMed
10.
Keel MJ, Tomagra S, Bonel HM, Siebenrock KA, Bastian JD. Clinical results of acetabular fracture management with the Pararectus approach. Injury. 2014;45(12):1900–7.CrossRefPubMed
11.
Wenzel L, von Rüden C, Thannheimer A, Becker J, Brand A, Augat P, Perl M. The Pararectus Approach in Acetabular Surgery: Radiological and Clinical Outcome. J Orthop Trauma. 2020;34(2):82–8.CrossRefPubMed
12.
Mu W-d, Wang X-q, Jia T-h, Zhou D-s, Cheng A-x. Quantitative anatomic basis of antegrade lag screw placement in posterior column of acetabulum. Arch Orthop Trauma Surg. 2009;129(11):1531–7.CrossRefPubMed
13.
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am Vol. 1969;51(4):737–55.CrossRef
14.
d’Aubigne RM, Postel M. The classic: functional results of hip arthroplasty with acrylic prosthesis. 1954. Clin Orthop Relat Res. 2009;467(1):7–27.CrossRefPubMed
15.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40.PubMed
16.
Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum. Early results of a prospective study. Clin Orthop Relat Res. 1986;(205):241–50.
17.
Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632–45.CrossRefPubMed
18.
Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective. Clin Orthop Relat Res. 1994;(305):10–9.
19.
Andersen RC, O’Toole RV, Nascone JW, Sciadini MF, Frisch HM, Turen CW. Modified stoppa approach for acetabular fractures with anterior and posterior column displacement: quantification of radiographic reduction and analysis of interobserver variability. J Orthop Trauma. 2010;24(5):271–8.CrossRefPubMed
20.
von Rüden C, Wenzel L, Becker J, Thannheimer A, Augat P, Woltmann A, Bühren V, Perl M. The pararectus approach for internal fixation of acetabular fractures involving the anterior column: evaluating the functional outcome. Int Orthop. 2018;43(6):1487–93.CrossRef
21.
22.
Ochs BG, Marintschev I, Hoyer H, Rolauffs B, Culemann U, Pohlemann T, Stuby FM. Changes in the treatment of acetabular fractures over 15 years: Analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU). Injury. 2010;41(8):839–51.CrossRefPubMed
23.
Ciolli G, De Mauro D, Rovere G, Smakaj A, Marino S, Are L, et al. Anterior intrapelvic approach and suprapectineal quadrilateral surface plate for acetabular fractures with anterior involvement: a retrospective study of 34 patients. BMC Musculoskelet Disord. 2021;22(Suppl 2):1060.CrossRefPubMedPubMedCentral
24.
Soni A, Gupta R, Vashisht S, Kapoor A, Sen R. Combined Anterior Pelvic (CAP) approach for fracture acetabulum fixation - Functional outcome evaluation and predictors of outcome. J Clin Orthop Trauma. 2020;11(6):1136–42.CrossRefPubMedPubMedCentral
25.
Jang JH, Moon NH, Rhee SJ, Jung SJ, Ahn TY. Surgical outcomes of transverse acetabular fractures and risk factors for poor outcomes. BMC Musculoskelet Disord. 2021;22(1):222.CrossRefPubMedPubMedCentral
26.
Laflamme GY, Hebert-Davies J, Rouleau D, Benoit B, Leduc S. Internal fixation of osteopenic acetabular fractures involving the quadrilateral plate. Injury. 2011;42(10):1130–4.CrossRefPubMed
27.
Elmadağ M, Güzel Y, Acar MA, Uzer G, Arazi M. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: A case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res. 2014;100(6):675–80.CrossRefPubMed
28.
Isaacson MJ, Taylor BC, French BG, Poka A. Treatment of acetabulum fractures through the modified Stoppa approach: strategies and outcomes. Clin Orthop Relat Res. 2014;472(11):3345–52.CrossRefPubMedPubMedCentral
29.
Bastian JD, Tannast M, Siebenrock KA, Keel MJ. Mid-term results in relation to age and analysis of predictive factors after fixation of acetabular fractures using the modified Stoppa approach. Injury. 2013;44(12):1793–8.CrossRefPubMed
30.
Elhassan Y, Abdelhaq A, Piggott RP, Osman M, McElwain JP, Leonard M. Heterotopic Ossification following acetabular fixation: Incidence and risk factors: 10-year experience of a tertiary centre. Injury. 2016;47(6):1332–6.CrossRefPubMed
31.
Firoozabadi R, Alton T, Sagi HC. Heterotopic Ossification in Acetabular Fracture Surgery. J Am Acad Orthop Surg. 2017;25(2):117–24.CrossRefPubMed
32.
Firoozabadi R, Stafford P, Routt M. Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated Using an Ilioinguinal Exposure. Arch Bone Joint Surg. 2015;3(4):274–9.PubMedPubMedCentral
33.
Mardian S, Schaser KD, Hinz P, Wittenberg S, Haas NP, Schwabe P. Fixation of acetabular fractures via the ilioinguinal versus pararectus approach: a direct comparison. Bone Joint J. 2015;97-B(9):1271–8.CrossRefPubMed
34.
Bastian JD, Savic M, Cullmann JL, Zech WD, Djonov V, Keel MJ. Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa. Injury. 2016;47(3):695–701.CrossRefPubMed
Metadata
Title
The Pararectus approach in acetabular fractures treatment: functional and radiologcial results
Authors
Guoming Liu
Jinli Chen
Chengzhi Liang
Chengdong Zhang
Xuwen Li
Yanling Hu
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-022-05275-z

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