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The Pararectus Approach to the Acetabulum

  • Johannes D. BastianEmail author
  • Marius J. B. Keel
Chapter
Part of the Fracture Management Joint by Joint book series (FMJJ)

Abstract

The appearance of acetabular fractures involving predominantly the anterior column has changed following an increase in elderly trauma. In elderly, a greater prevalence of quadrilateral plate fractures and acetabular dome impaction due to medial protrusion of the femoral head is noticed. The Pararectus approach provides distinct and safe surgical, intrapelvic, extraperitoneal access from anterior directly above the hip joint. The Pararectus approach combines the advantages of the ilioinguinal approach and Stoppa approach with access through the second window, however, without the need to dissect the inguinal canal (ilioinguinal approach) and without losing any direct access to the hip joint (Stoppa approach).

Keywords

Acetabulum Fracture Anterior column Dome impaction Quadrilateral plate Exposure Anterior Intrapelvic Extraperitoneal 

References

  1. 1.
    Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am. 1964;46:1615–46.CrossRefGoogle Scholar
  2. 2.
    Hirvensalo E, Lindahl J, Bostman O. A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res. 1993;297:28–32.Google Scholar
  3. 3.
    Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994;305:112–23.CrossRefGoogle Scholar
  4. 4.
    Ponsen KJ, Joosse P, Schigt A, Goslings JC, Luitse JS. Internal fracture fixation using the Stoppa approach in pelvic ring and acetabular fractures: technical aspects and operative results. J Trauma. 2006;61(3):662–7.CrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    Sagi HC, Afsari A, Dziadosz D. The anterior intra-pelvic (modified Rives-Stoppa) approach for fixation of acetabular fractures. J Orthop Trauma. 2010;24(5):263–70.CrossRefGoogle Scholar
  7. 7.
    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.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Khoury A, Weill Y, Mosheiff R. The Stoppa approach for acetabular fracture. Oper Orthop Traumatol. 2012;24(4–5):439–48.CrossRefGoogle Scholar
  10. 10.
    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.CrossRefGoogle Scholar
  11. 11.
    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;472:3345–52.CrossRefGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    Ma K, Luan F, Wang X, et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics. 2013;36(10):e1307–e15.CrossRefGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    Bastian JD, Giannoudis PV. Central acetabular fracture dislocations: are existing classifications comprehensive? Injury. 2014;45(12):1807–15.CrossRefGoogle Scholar
  17. 17.
    Prasartritha T, Chaivanichsiri P. The study of broken quadrilateral surface in fractures of the acetabulum. Int Orthop. 2013;37(6):1127–34.CrossRefGoogle Scholar
  18. 18.
    Keel MJ, Ecker TM, Cullmann JL, et al. 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.CrossRefGoogle Scholar
  19. 19.
    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;47:695.CrossRefGoogle Scholar
  20. 20.
    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.CrossRefGoogle Scholar
  21. 21.
    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.CrossRefGoogle Scholar
  22. 22.
    von Rüden C, Wenzel L, Becker J, Thannheier 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. International orthopaedics. 2018.  https://doi.org/10.1007/s00264-018-4148-8 CrossRefGoogle Scholar
  23. 23.
    Keel MJB, Siebenrock KA, Tannast M, Bastian JD. The Pararectus approach: a new concept. JBJS Essent Surg Tech. 2018;8(3):e21.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic and Trauma SurgeryInselspital, University HospitalBernSwitzerland
  2. 2.Trauma Center Hirslanden, Clinic HirslandenZürichSwitzerland

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