Surgical treatment of complex acetabular fractures through the lateral-rectus approach with the pelvic reconstructive plate and antegrade posterior-column lag screw

ZHANG Xiao; YANG Xiao-dong; XIA Guang; LI Tao; WANG Hua; XIONG Ran; FAN Shi-cai

Abstract：Objective To evaluate the clinical value of the lateral-rectus approach with the pelvic recon-structive plate and antegrade posterior -column lag screw in the treatment of complex acetabular fractures .Meth-ods Between May 2012 and Jan.2014,9 patients with complex acetabular fractures were treated with pelvic recon-structive plate and antegrade posterior-column lag screw through the lateral-rectus approach . There were 6 males and 3 females,aged 27-74 years(mean,39 years).Fractures were caused by traffic accident in 5 cases,by falling in 2 cases,and by heavy crash in 2 cases.According to Letournel classification ,there were 2 cases of transverse frac-ture,4 cases of anterior column with posterior hemi-transverse lesion fracture,and 3 cases of both-column fracture with 1 case of central dislocation of hip joint .The operation time and blood loss were statistically analyzed .The pa-tients were evaluated clinically according to Merle d'Aubigne-Postel scoring system and X ray performance based on the criteria described by Matta .Results The average time of operation was 200 minutes ( 150-255 minutes );the average blood loss was 730ml(300-1250ml);the average follow up was 15.9 months(9-30 months);the clinical results were excellent in 5 patients,good in 2 and fair in 2.The radiological results were anatomical reduction in 5 patients,satisfactory in 3 and fair in 1.All the patients were healed within 3 months and there were no complications such as infection ,avascular necrosis of the femoral head ( ANFH) ,or heterotopic ossification .Conclusion The lat-eral-rectus approach is suitable for some complex acetabular fractures ,with advantages of the adequate exposure of quadrilateral surface and insertion of the posterior column antegrade lag screw .