The Pararectus Approach in Acetabular Surgery: Radiological and Clinical Outcome.

ABSTRACT

OBJECTIVES: To evaluate radiological fracture reduction and clinical results using the pararectus approach in complex acetabular fractures involving the anterior column. DESIGN: Retrospective database analysis of prospectively collected data. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: 61 patients (48 male and 13 female) with a median age of 55 (range 17-91) years were included. According to the chosen surgical approach, they were divided into 2 groups. The P-group included 43 patients, among them 32 male and 11 female patients with a median age of 55 (range 17-90) years. Eighteen patients [16 male, 2 female; median age 53 (range 23-91) years] were treated through the ilioinguinal approach (I-group). INTERVENTION Anterior surgical procedures through the pararectus or the ilioinguinal approach. MAIN OUTCOME MEASURED Reduction results were rated according to the modified Matta criteria using a measurement protocol of hip joint gaps and steps in computed tomography scans. Operation time, complications, and clinical outcomes median one year postoperatively were compared. RESULTS: In the pararectus group reduction was anatomical in 21 out of 40 analyzed patients (52.5%), imperfect in 11 patients (27.5%), and poor in 8 patients (20%). The mean joint step reduction was 3.7 mm, and the mean joint gap reduction was 12.1 mm. In the ilioinguinal group reduction was anatomical in 9 out of 18 patients (50%), imperfect in 4 patients (22%), and poor in 5 patients (28%). The mean joint step reduction was 1 mm, and the mean joint gap reduction was 7 mm. Operation time was significantly shorter in the P-group (mean 49 minutes; P < 0.001). CONCLUSIONS: This study indicates that acetabular fracture reduction using the pararectus approach is at least comparable with the ilioinguinal approach independent of patients' age. A relevant advantage of the pararectus approach was seen in a significantly shorter operation time. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.