The Pararectus approach for anterior intrapelvic management of acetabular fractures: An anatomical study and clinical evaluation

ArticleinThe Bone & Joint Journal 94(3):405-11 · March 2012with245 Reads
DOI: 10.1302/0301-620X.94B3.27801 · Source: PubMed
Abstract
A new anterior intrapelvic approach for the surgical management of displaced acetabular fractures involving predominantly the anterior column and the quadrilateral plate is described. In order to establish five 'windows' for instrumentation, the extraperitoneal space is entered along the lateral border of the rectus abdominis muscle. This is the so-called 'Pararectus' approach. The feasibility of safe dissection and optimal instrumentation of the pelvis was assessed in five cadavers (ten hemipelves) before implementation in a series of 20 patients with a mean age of 59 years (17 to 90), of whom 17 were male. The clinical evaluation was undertaken between December 2009 and December 2010. The quality of reduction was assessed with post-operative CT scans and the occurrence of intra-operative complications was noted. In cadavers, sufficient extraperitoneal access and safe instrumentation of the pelvis were accomplished. In the patients, there was a statistically significant improvement in the reduction of the fracture (pre- versus post-operative: mean step-off 3.3 mm (sd 2.6) vs 0.1 mm (sd 0.3), p < 0.001; and mean gap 11.5 mm (sd 6.5) vs 0.8 mm (sd 1.3), p < 0.001). Lesions to the peritoneum were noted in two patients and minor vascular damage was noted in a further two patients. Multi-directional screw placement and various plate configurations were feasible in cadavers without significant retraction of soft tissues. In the treatment of acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach allowed anatomical restoration with minimal morbidity related to the surgical access.
    • "Again calcium phosphate was used as void filler. Keel et al. [2,17] as well present good outcomes of fractures with AMDI using the pararectus approach. "
    Article · Aug 2016
    • "The medial positioning of the plate fixation is easier, while the positioning of the screws for a plate applied on the cranial side is more difficult. The prevailing pararectus approach, [3] which emerged in the past five years, combines the advantages of both the Judet-Letournel and Stoppa approaches. It is less invasive, the quadrilateral surface is exposed, and the external iliac artery and vein are handled safely, since they are mobilized and secured. "
    Article · Dec 2015 · Injury
    • "The description of safe zones of implant placement and the techniques/instruments/ implants that have been developed specifically in relation to this approach represent the major contemporary progresses noted. The newly introduced Pararectus approach [21,22] seems promising in addressing specific fracture pathologies such as geriatric fractures but more data from clinical studies are needed to conclude on its safety and efficacy [23]. "
    [Show abstract] [Hide abstract] ABSTRACT: Literature in acetabular fracture surgery is lavish but truly meaningful studies that add something new are sparse. The few new epidemiological studies confirm that the elderly population with acetabular fractures is on the rise. Paediatric acetabular fractures have gained some attention but we still do not have full appreciation of their true incidence amongst the paediatric trauma population and their long-term functional outcome. The routine use of the Judet views has been questioned and the 3D CT reconstruction is gaining popularity as a diagnostic tool. Interac-tive technology seems to have a clear advantage in teaching and training compared with more traditional methods. Newer approaches and reduction techniques expand the horizons of the surgeon but their efficacy compared with classical methods of reduction and fixation is yet to be proven. Navigation technology although promising, has not yet been widely incorporated in everyday in clinical practice. Scanty evidence is available in relation to patient related outcome measures after acetabular fracture surgery. Of note is the almost absolute lack of evidence in relation to rehabilitation after acetabular fracture surgery and we would urge the orthopaedic traumatology community to look into that issue in the very near future.
    Article · Nov 2015
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