The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation

Keel, M J B; Ecker, T M; Cullmann, J L; Bergmann, M; Bonel, H M; Büchler, L; Siebenrock, K A; Bastian, Johannes D. (2012). The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. Journal of bone and joint surgery - British volume, 94(3), pp. 405-11. London: British Editorial Society of Bone and Joint Surgery 10.1302/0301-620X.94B3.27801

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A new anterior intrapelvic approach for the surgical management of displaced acetabular fractures involving predominantly the anterior column and the quadrilateral plate is described. In order to establish five 'windows' for instrumentation, the extraperitoneal space is entered along the lateral border of the rectus abdominis muscle. This is the so-called 'Pararectus' approach. The feasibility of safe dissection and optimal instrumentation of the pelvis was assessed in five cadavers (ten hemipelves) before implementation in a series of 20 patients with a mean age of 59 years (17 to 90), of whom 17 were male. The clinical evaluation was undertaken between December 2009 and December 2010. The quality of reduction was assessed with post-operative CT scans and the occurrence of intra-operative complications was noted. In cadavers, sufficient extraperitoneal access and safe instrumentation of the pelvis were accomplished. In the patients, there was a statistically significant improvement in the reduction of the fracture (pre- versus post-operative: mean step-off 3.3 mm (sd 2.6) vs 0.1 mm (sd 0.3), p < 0.001; and mean gap 11.5 mm (sd 6.5) vs 0.8 mm (sd 1.3), p < 0.001). Lesions to the peritoneum were noted in two patients and minor vascular damage was noted in a further two patients. Multi-directional screw placement and various plate configurations were feasible in cadavers without significant retraction of soft tissues. In the treatment of acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach allowed anatomical restoration with minimal morbidity related to the surgical access.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Anatomy

UniBE Contributor:

Keel, Marius; Ecker, Timo; Cullmann, Jennifer; Bergmann, Mathias; Bonel, Harald Marcel; Büchler, Lorenz; Siebenrock, Klaus-Arno and Bastian, Johannes Dominik

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0301-620X

Publisher:

British Editorial Society of Bone and Joint Surgery

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:30

Last Modified:

30 Jul 2014 14:07

Publisher DOI:

10.1302/0301-620X.94B3.27801

PubMed ID:

22371551

Web of Science ID:

000301469000021

URI:

https://boris.unibe.ch/id/eprint/11558 (FactScience: 217760)

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