The Pararectus approach for anterior intrapelvic management of acetabular fractures

2012 ◽  
Vol 94-B (3) ◽  
pp. 405-411 ◽  
Author(s):  
M. J. B. Keel ◽  
T. M. Ecker ◽  
J. L. Cullmann ◽  
M. Bergmann ◽  
H. M. Bonel ◽  
...  
Keyword(s):  
Acetabular Fractures ◽  
Pararectus Approach

Short-column acetabular fracture fixation through a mini-pararectus approach in anteriorly displaced acetabular fractures

2019 ◽  
Vol 30 (6) ◽  
pp. 539-543
Author(s):  
Mahmoud Badran ◽  
Osama Farouk ◽  
Ayman Kamal ◽  
Hossam Abubeih ◽  
Mohamed Khaled
Keyword(s):  
Fracture Fixation ◽  
Acetabular Fracture ◽  
Acetabular Fractures ◽  
Short Column ◽  
Pararectus Approach

scholarly journals The Treatment Advantage of Complex Acetabular Fractures by the Pararectus Approach

2021 ◽  
Author(s):  
Guoming Liu ◽  
Jinli Chen ◽  
Chengzhi Liang ◽  
Chengdong Zhang ◽  
Xuwen Li ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Operating Time ◽  
Hip Osteoarthritis ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Heterotopic Bone ◽  
Heterotopic Bone Formation ◽  
Orthopedic Surgeons ◽  
Pararectus Approach

Abstract Background: The surgical treatment of complex acetabular fractures is one of the most challenging procedures for orthopedic surgeons. The Pararectus approach, as a reasonable alternative to the existing surgical procedures, was performed for the treatment of complex acetabular fractures involving the anterior column. This study aimed to evaluate outcome using the Pararectus approach for acetabular fractures involving anterior columns. Methods: Thirty-seven with displaced complex acetabular fractures involving anterior columns were treated between July 2016 and October 2019 using the Pararectus approach. The functional outcomes (using the Merle d Aubigné and Postel scoring system, WOMAC and modified Harris scoring), the quality of surgical reduction (using the Matta criteria), and postoperative complications were assessed with about 26 months follow-up.Results: Thirty-seven patients (mean age 53 years, range: 30-71; 28 male) underwent surgery. Mean intraoperative blood loss was 840 ml (rang: 400-2000 ml) and mean operating time was 210 min (rang: 140-500 min). The modified Merle d Aubigné score was excellent and good in 27 cases (73%), fair in 6 cases (16%), and poor in 3 cases (12%). The mean score was 88.5 (range:77-96) for the modified Harris Hip scores, and 22 (range:7-35) for the WOMAC scores after operation. Postoperative functional outcomes were significantly improved compared with preoperative outcomes (P<0.0001). The quality of reduction was anatomical in 21 cases (57%), satisfactory in 9 cases (24%), and unsatisfactory in 7 cases (20%). At follow-up, four patients developed a DVT, and heterotopic bone formation was observed in one patient. The hip osteoarthritis was not observed.Conclusion: The Pararectus approach achieved good functional outcomes and anatomical reduction in the treatment of complex acetabular fractures involving anterior column with minimal access morbidity.

scholarly journals Therapeutic effect of acetabular fractures using the Pararectus approach combined with 3D printing technique

2020 ◽  
Author(s):  
Ruyi Zou ◽  
Min Wu ◽  
Jianzhong Guan ◽  
Yuzhou Xiao ◽  
Xiaotian Chen
Keyword(s):  
3D Printing ◽  
Three Dimensional ◽  
Operation Time ◽  
Acetabular Fractures ◽  
Effective Reduction ◽  
Printing Technique ◽  
Dimensional Reconstruction ◽  
Hip Function ◽  
Pararectus Approach ◽  
3D Printing Technique

Abstract Background To explore the clinical efficacy of pararectus approach combined with 3D printing technique for the surgical treatment of partial complex acetabular fractures. Methods We retrospectively evaluated 18 (11 males and 7 females) patients with complicated acetabular fractures in the period of June 2017 to December 2018; According to judet-letenneal classification: 11 cases were of double column fracture, 6 fractures were of the anterior column with posterior half transverse, and 1 case was of "T" fracture. For all cases, 3D printing is used to print the acetabular model. Pre-bent reconstruction plates from the model were placed to fixate fractures after reduction via the pararectus approach. Results The average time of surgery was 203 min (range:135-245 min)and mean intraoperative blood loss was 1030ml(range:450-1400ml);18 patients were followed up for 12-18 months (average,14 months);One patient (5.6%) developed postoperative wound infection, and the wound completely improved by secretion culture, enhanced dressing and effective antibiotics. One patient (5.6%) developed postoperative ossifying myositis, and there are no obvious symptoms at present; all patients underwent pelvic films and pelvic CT+ three-dimensional reconstruction after surgery, suggesting that fractures reduction as well. All the acetabular fractures united after 12 to 16 weeks(average,13 weeks);According to the modified Merle d’Aubigne and Postel scoring system to assess the hip function: excellent in 13 cases (72.2%), good in 3 cases(16.7%) and fair in 2 cases(11.1%). Conclusions In the treatment of partial complex acetabular fractures, the pararectus approach combined with 3D printing technique can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time and the internal fixation position can be properly adjusted during the operation by looking directly at the model.

Pararectus-approach vs. Stoppa-approach for the treatment of acetabular fractures - a comparison of clinical and operative outcome parameters

2020 ◽  
Author(s):  
MA Küper ◽  
B Röhm ◽  
U Stöckle ◽  
FM Stuby ◽  
A Höch ◽  
...  
Keyword(s):  
Acetabular Fractures ◽  
Outcome Parameters ◽  
Stoppa Approach ◽  
Operative Outcome ◽  
Pararectus Approach

Risk of Injury to the Neurovascular Structures in the Pararectus Approach Used in Acetabular Fractures: A Cadaver Study

2021 ◽  
Vol 35 (1) ◽  
pp. e13-e17
Author(s):  
Yusuf A. Kati ◽  
Ozkan Kose ◽  
Baver Acar ◽  
Adil Turan ◽  
Serra Ozturk ◽  
...  
Keyword(s):  
Cadaver Study ◽  
Acetabular Fractures ◽  
Risk Of Injury ◽  
Pararectus Approach ◽  
Neurovascular Structures

Early biomechanical outcome in patients with acetabular fractures treated using the pararectus approach: a gait and stair climb analysis study

2021 ◽  
Author(s):  
Andreas Brand ◽  
Christian von Rüden ◽  
Carina Probst ◽  
Lisa Wenzel ◽  
Peter Augat ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Ground Reaction Force ◽  
Reaction Force ◽  
Acetabular Fractures ◽  
Functional Evaluation ◽  
Vertical Ground Reaction Force ◽  
Pararectus Approach ◽  
Vertical Ground ◽  
Hip Muscles ◽  
Hip Extension

Abstract Purpose Patients with surgically treated acetabular fractures using extensive dissection of hip muscles demonstrate an incomplete biomechanical recovery and limited joint mobility during movement. The purpose of this study was to evaluate the early biomechanical outcome in a series of patients with acetabular fractures treated using the less invasive anatomical pararectus approach. Methods Eight patients (48 ± 14 years, BMI 25.8 ± 3 kg/m2) were investigated 3.8 ± 1.3 months after surgery and compared to matched controls (49 ± 13 years, BMI 26 ± 2.8 kg/m2). Trunk and lower extremity kinematics and kinetics during gait and stair climb were calculated. SF-12 and the Merle d’Aubigné score were used for functional evaluation. Statistical analysis was conducted using Mann–Whitney test and Student’s t test. Effect sizes were calculated using Cohen’s d. Results No group differences for lower extremity kinematics during walking and stair climbing were found. During walking, patients showed significant reductions (p < 0.05) of the vertical ground reaction force (8%) and knee and hip extension moments (29 and 27%). Ipsilateral trunk lean was significantly increased by 3.1° during stair descend while reductions of vertical ground reaction force were found for stair ascend (7%) and descend (20%). Hip extension moment was significantly reduced during stair descend by 37%. Patients revealed acceptable SF-12 physical and mental component outcomes and a good rating for the Merle d’Aubigné score (15.9 ± 1.7). Conclusion Patients showed some biomechanical restrictions that can be related to residual deficits in weight bearing capacity and strength of the hip muscles. In contrast, an immediate recovery of mobility was achieved by preserving lower extremity and pelvic movement. Therefore, the pararectus approach can serve as a viable strategy in the surgical treatment of acetabular fractures. Clinical trial Trial registration number DRKS00011308, 11/14/2016, prospectively registered.

scholarly journals Internal Fixation of Anterior Acetabular Fractures with a Limited Pararectus Approach and the New Anatomical Plates: Preliminary Results

2020 ◽  
Author(s):  
Sheng Yao ◽  
Kaifang Chen ◽  
Fengzhao Zhu ◽  
Jia Liu ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Internal Fixation ◽  
Functional Outcomes ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Invasive Approach ◽  
Residual Displacements ◽  
Quadrilateral Plate ◽  
Pararectus Approach ◽  
Transverse Fractures

Abstract Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the new anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with minimally invasive approach and the new anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The new anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the new anatomical plates successfully. The mean operative time and blood loss were 90.9 minutes and 334.1 ml, respectively. The average postoperative residual gap and step displacement were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.Conclusions The limited pararectus approach with the advantages of more minimally invasive and less complications can be an alternative choice for simple anterior acetabular fractures especially involving the quadrilateral plate. The new anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction.

scholarly journals Therapeutic effect of acetabular fractures using the Pararectus approach combined with 3D printing technique

2020 ◽  
Author(s):  
Ruyi Zou ◽  
Min Wu ◽  
Jianzhong Guan ◽  
Yuzhou Xiao ◽  
Xiaotian Chen
Keyword(s):  
3D Printing ◽  
Operation Time ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Transverse Fracture ◽  
Effective Reduction ◽  
Printing Technique ◽  
Hip Function ◽  
Pararectus Approach ◽  
3D Printing Technique

Abstract Objective: To explore the clinical efficacy of pararectus approach combined with 3D printing technique for the surgical treatment of partial acetabular fractures.Methods: We retrospectively evaluated 33 (20 males and 13 females) patients with acetabular fractures in the period of June 2017 to December 2018; According to judet-letenneal classification: 11 cases were of anterior column fracture, 10 cases were of double column fracture, 7 fractures were of the anterior column with posterior half transverse,3 fractures were of transverse fracture, and 2 case was of "T" fracture. For all cases, 3D printing is used to print the acetabular model. Pre-bent reconstruction plates from the model were placed to fixate fractures via the pararectus approach. Results : Thirty-three patients were followed up for 12-18 months (average,14 months); two patients (6.0%) developed postoperative ossifying myositis, and there are no obvious symptoms at present; One patient (3.0%) developed postoperative wound infection, and the wound completely improved by secretion culture, enhanced dressing and effective antibiotics; All the acetabular fractures united after 12 to 16 weeks(average,13 weeks);According to the modified Merle d’Aubigne and Postel scoring system to assess the hip function: excellent in 22 cases (66.7%), good in 7 cases(21.2%) and fair in 4 cases(12.1%).Conclusions: In the treatment of partial acetabular fractures, the pararectus approach combined with 3D printing technique can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time and the internal fixation position can be properly adjusted during the operation by looking directly at the model.

scholarly journals Internal fixation of anterior acetabular fractures with a limited pararectus approach and the anatomical plates: preliminary results

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sheng Yao ◽  
Kaifang Chen ◽  
Fengzhao Zhu ◽  
Jia Liu ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcomes ◽  
Adverse Outcomes ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Residual Displacements ◽  
Quadrilateral Plate ◽  
Limited Surgery ◽  
Pararectus Approach ◽  
Transverse Fractures

Abstract Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 min and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively. Conclusions The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.

scholarly journals Internal fixation of anterior acetabular fractures with a limited pararectus approach and the anatomical plates: preliminary results

2020 ◽  
Author(s):  
Sheng Yao ◽  
Kaifang Chen ◽  
Fengzhao Zhu ◽  
Jia Liu ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcomes ◽  
Adverse Outcomes ◽  
Anterior Column ◽  
Acetabular Fractures ◽  
Residual Displacements ◽  
Quadrilateral Plate ◽  
Limited Surgery ◽  
Pararectus Approach ◽  
Transverse Fractures

Abstract Background The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates. Methods A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted. Results All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 minutes and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.Conclusions The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.

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