Operative treatment of acetabular both-column fracture through single lateral-rectus approach

Objective To explore the clinical effect and surgical skills of single lateral-rectus approach for the internal fixation of both-column acetabular fractures, in which the anterior column was fixed by reconstruction plates and the posterior column was fixed by antegrade lag screws. Methods From January 2012 to June 2014, 28 patients with both-column acetabular fractures were surgically managed through a single lateral-rectus approach. They were 12 males and 16 females, with an average age of 41.4 (range, 19-61) years. According to Judet-Letournel classification, there were 18 of anterior column with posterior hemitransverse fractures, 10 of both-column fractures. All these fractures were treated through the lateral-rectus approach, in the horizontal position with general anesthesia. The pre-bended plate was placed in interior pelvic ring to fix the anterior column after reduction of the acetabular fracture. The ischial spine was exposed along the interior quadrilateral surface to reduce posterior column fractures. Then, the posterior column was fixed by antegrade lag screw (6.5 mm) after a hook-wire was implanted in posterior column along the ischial spine. Results All the 28 cases underwent the operation successfully. Postoperative X-ray and CT exams showed excellent or good reduction of anterior column and posterior column, without any operative complications. According to the Matta radiological evaluation, the reduction of acetabular fracture was rated as excellent in 20 cases, good in 5 cases and fair in 3 cases. The rate of excellent and good was 89.20% (25/28). All patients were followed up for 6 to 18 months and all patients had achieved bone union. According to the modified Merle d'Aubigne and Postel scoring system, 19 cases were excellent, 7 good, and 2 fair after operation. The rate of excellent and good was 92.8% (26/28). 2 cases occurred postoperative pain when walking, X-ray shows traumatic osteoarthritis. Conclusion Surgical management of acetabular fractures through a single lateral-rectus approach can provide adequate exposure of the anterior columns and the medial surface of posterior column, and this approach could also provide excellent visual control of reduction and fixation. Key words: Acetabulum; Fractures, bone; Bone screws