gms | German Medical Science

Objectives: The pararectus approach has been proposed in 2012 by Keel et al. as an alternative and novel approach to the ventral and medial aspects of the acetabulum. In this study we investigated the radiological outcome in a level 1 trauma center over a period of 2 years establishing the pararectus approach for selected acetabular fractures.

Methods: A retrospective database analysis for acetabular fractures operated in 2013 and 2014 with the pararectus approach was carried out. Clinical data (age, gender, date of injury etc.) was recorded. Preoperative CT-scans were used for fracture classification. Postoperative CT-scans were used to evaluate the degree of reduction as follows: Around the center of the acetabulum, a sector was scanned from 2cm anterior to posterior in the coronal and 2cm medial to lateral in the sagittal plane with a 45 degree angle to each side. Within this sector, representing the weight bearing part of the acetabulum, the greatest degree of dislocation was recorded and graded according to Matta into anatomical ( ≤ 1mm step), 2-3mm (imperfect) and > 3mm (poor). Classification of fractures and evaluation of reduction results were performed independently by two observers.

Results and Conclusion: 216 acetabular fractures were treated in our hospital in 2013/14. 87 were operated. 23 patients (17 male/ 6 female) were operated using the pararectus approach. In 21 patients primary osteosynthesis of the acetabulum was performed, two patients were prepared for later total hip replacement. The age (mean±SD) was 56±20 years and the time from trauma to the operation was 5±4 (mean±SD) days. From the 21 patients n=14 were diagnosed with 2-column fractures, n=4 with transverse-fractures and n=3 with anterior column posterior hemitransverse fractures. In all but one patient, significant dislocation of the fracture fragments was present preoperatively. N=6 patients were treated with one, n=13 with two and n=2 with three titanium small fragments plates. In 18 patients anatomical reduction ( ≤ 1mm step) and in three patients imperfect reduction (2-3mm step) was achieved as evidenced by postoperative CT-films. Imperfect results all occurred in 2-column fractures. No poor reduction results occurred. In addition, no major complications occurred. One patient required revision surgery and evacuation of hematoma formation on postoperative day 5 due to postoperative hemorrhage.

The results of this study suggest, that the pararectus approach is a reliable and safe surgical approach to the acetabulum and offers direct visualization, direct reduction, and stabilization of fracture fragments affecting the quadrilateral plate and the weight bearing dome.