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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.