- 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);
- The Spur Sign
- Both Column Frx
- 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.
Non-extensive surgical approaches for two column acetabular fractures.
The extended ilioinguinal approach for specific both column fractures.
Entrapment of the External Iliac Vein in a Both-Column Acetabular Fracture.