Increased Anterior Column Exposure Using the Anterior Intrapelvic Approach Combined With an Anterior Superior Iliac Spine Osteotomy: A Cadaveric Study

To determine whether the addition of an anterior superior iliac spine (ASIS) osteotomy to the lateral window, when combined with the anterior intrapelvic (AIP) surgical approach, would improve visualization of the iliopectineal eminence and allow for predictable and safe clamp application.Ten lateral window approaches to the iliac fossa were developed in conjunction with the AIP approach on 10 fresh-frozen cadaveric pelvi. A calibrated digital image was taken from the surgeon's optimal viewing angle to capture the visualized osseous surface of the false pelvis with emphasis on the iliopectineal eminence. An ASIS osteotomy was then performed and an additional calibrated image was obtained to identify any increased visualization of the iliopectineal eminence. Using ImageJ software (NIH, Bethesda, MD), the additional surface area afforded to the surgeon was calculated. An AIP approach was then performed to confirm complete exposure of the anterior column and whether a Weber clamp could safely be placed across the iliopectineal eminence.The lateral window, osteotomy, and AIP approach were successfully accomplished in all 10 specimens. Before performing an ASIS osteotomy, a mean of 20.3 cm (range: 14.5-25.6 cm) of the false pelvis adjacent to the pelvic brim was visualized. After completion of the osteotomy, the mean visualized surface area increased significantly to 28.4 cm (range: 14.6-45.6 cm) (P < 0.0168). Clamp placement through the lateral window was unsuccessful in all 10 specimens. After completion of the AIP approach, complete visualization of the iliopectineal eminence was confirmed and safe clamp application through the lateral window possible in all 10 specimens.ASIS osteotomy through the lateral window significantly improved visualization and access to the iliopectineal eminence in this cadaveric model, which suggests that it may be a suitable alternative to the traditional ilioinguinal approach for select fracture patterns when combined with an AIP approach.