- Discussion:
- approach is similar to
Smith Peterson;
- provides exposure to the outer aspect of the iliac bone and gives exposure of the
anterior and
posterior columns;
- extended
iliofemoral approach provides best
access to
both column fractures (esp w/ greater sciatic notch involvement) & allows best assessment of reduction;
- indicated for transtectal transverse fractures and transtectal transverse fractures with posterior wall fractures;
- this approach is used for anterior column and
anterior wall frx w/ no extension distal to the iliopectineal eminence;
- this approach does not allow access distal to iliopectineal eminence, but if the fracture occurs above that, this incision may be used;
- lag screw compression fixation of
anterior column frx is possible thru this approach, but plate cannot be used due to poor visualization;
- proximal plates may be fixed to the ilium with ease;
- Technique:
- superficially: dissection is made between
sartorius &
tensor fascia lata;
- deep layers: dissection is made between
rectus femoris &
gluteus medius;
- dissection is between lateral femoral cutaneous nerve &
superior gluteal nerves;
- ascending branch of
LFCA is encountered distal to the hip joint;
- exposure may be increased by adduction & internal rotation of hip joint;
- Complications:
-
heterotopic bone:
- commonly occurs following lateral exposure of innominate bone;
- occurs more frequently w/ extended iliofemoral approach as compared to
Kocher Langenbeck approach, or
Ilioinguinal Approach;
- prophylaxis includes
indomethacin (25 mg tid for several months) or postoperative radiation;
- if ectopic bone occurs, its excision is delayed for at least 15-18 mo;
Extended iliofemoral versus triradiate approaches in management of associated acetabular fractures.
A modified extensile exposure for the treatment of complex or malunited acetabular fractures.
Treatment of complex acetabular fractures through a modified extended iliofemoral approach.
Safety and efficacy of the extended iliofemoral approach in the treatment of complex fractures of the acetabulum.
