- Discussion:
- both column frxs separate the roof from the iliac wing or sacroiliac joint (no articular segment remains attached
to a segment of the iliac wing or SI joint);
- Non Operative Rx:
- indicated only for fractures w/ apparent congruence of both columns;
- Surgical Approach:
- two-column frxs may require more extensive exposure than that afforded by either ilioinguinal or posterolateral approach alone;
-
ilioinguinal approach is used most often;
-
iliofemoral approach is used for both column frx which occur in the presence of frx extension into
the SI joint, wide separation of the columns, or w/ complex posterior column injuries;
- consider extended
ilioinguinal approach, or extended
iliofemoral approach;
- latter is preferable when there is complex
posterior column Frx or when frx lines cross
sacroiliac joint;
-
Kocher Langenbach approach can be used if combined with the middle window of the ilioinguinal approach;
-
anterior column is reduced and fixed to the ilium;
-
posterior column is then reduced & fixed, using interfragmentary lag screws and reconstruction or buttress plates;
Operative treatment of complex acetabular fractures: Combined anterior and posterior exposures during the same procedure.
ML Routt, MF Swiontkowski.
JBJS. Vol. 72-A. 1990. p 897-904.
Non-extensive surgical approaches for two column acetabular fractures.
CC Schmidt, GS Gruen.
JBJS. 75-B. 1993. 556-561.
The extended ilioinguinal approach for specific both column fractures. Clin Orthop 305:106-111, 1994 Weber TG, Mast JW:
Entrapment of the External Iliac Vein in a Both-Column Acetabular Fracture.
