The Hip: Preservation, Replacement and Revision

Iliofemoral Approach to the Acetabulum



- 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.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 6, 2012 3:16 pm