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Z Orthop Unfall 2021; 159(02): 144-152
DOI: 10.1055/a-1023-4756
Review/Übersicht

Risks and Strategies to Avoid Approach-Related Complications During Operative Treatment of Pelvic Ring or Acetabular Fractures

Article in several languages: English | deutsch
Markus Alexander Küper
1   Department for Trauma and Reconstructive Surgery, BG Hospital Tubingen
,
Alexander Trulson
2   Department for Trauma and Orthopaedic Surgery, BG Trauma Hospital Murnau
,
Christian Minarski
1   Department for Trauma and Reconstructive Surgery, BG Hospital Tubingen
,
Fabian Stuby
2   Department for Trauma and Orthopaedic Surgery, BG Trauma Hospital Murnau
,
Ulrich Stöckle
3   Centre for Musculoskeletal Surgery, Charité University Medicine Berlin
,
Christian Konrads
1   Department for Trauma and Reconstructive Surgery, BG Hospital Tubingen
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Abstract

Injuries of the pelvic ring or the acetabulum are either to be found in young patients with high energy trauma mechanisms or in geriatric patients after simple falls with very low impact energy. The indication for surgical stabilization is given by the grade of instability. Exact knowledge of the different possible surgical approaches is essential for the planning of the surgical treatment. Both, knowledge of reachable anatomical structures and possible risks of the different approaches are important. In this review, we summarize the standard surgical approaches to the pelvic ring and to the acetabulum. We describe the reachable anatomical structures for each approach, approach-related pitfalls, and we focus on strategies to reduce approach-related complications.

Key words

pelvis - symphysis - sacrum - corona mortis - osteoporosis


Publication History

Article published online:
03 December 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Fuchs T, Rottbeck U, Hofbauer V. et al. Beckenringfrakturen im Alter – Die unterschätzte osteoporotische Fraktur. Unfallchirurg 2011; 114: 663-670
    CrossrefPubMedGoogle Scholar
  • 2 Oberkircher L, Ruchholtz S, Rommens PM. et al. Osteoporotc pelvic fractures. Dtsch Arztebl Int 2018; 115: 70-80
    CrossrefPubMedGoogle Scholar
  • 3 Culemann U, Oestern HJ, Pohlemann T. Aktuelle Behandlung der Beckenringfraktur. Unfallchirurg 2014; 117: 145-161
    CrossrefPubMedGoogle Scholar
  • 4 Wagner D, Ossendorf C, Gruszka D. et al. Fragility fractures of the sacrum: how to identify and when to treat surgically?. Eur J Trauma Emerg Surg 2015; 41: 349-362
    CrossrefPubMedGoogle Scholar
  • 5 Culemann U, Oestern HJ, Pohlemann T. Aktuelle Behandlung der Beckenringfraktur. Chirurg 2013; 84: 809-826
    CrossrefPubMedGoogle Scholar
  • 6 Meinberg EG, Agel J, Roberts CS. et al. Fracture and Dislocation Classification Compendium–2018. J Orthop Trauma 2018; 32 (Suppl. 01) S1-S170
    CrossrefPubMedGoogle Scholar
  • 7 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 2013; 44: 1733-1744
    CrossrefPubMedGoogle Scholar
  • 8 Pieroh P, Höch A, Hohmann T. et al. Fragility fractures of the pelvis classification: a multicenter assessment of the intra-rater and inter-rater reliabilities and percentage of agreement. J Bone Joint Surg Am 2019; 101: 987-994
    CrossrefPubMedGoogle Scholar
  • 9 Rommens PM, Arand C, Hofmann A. et al. When and how to operate fragility fractures of the pelvis?. Indian J Orthop 2019; 53: 128-137
    CrossrefPubMedGoogle Scholar
  • 10 Pfannenstiel H. Über die Vorteile des suprasymphysären Fascienquerschnitts für die gynäkologischen Koliotomien. Zugleich ein Beitrag zu der Indikationsstellung der Operationswege. Sammlung klin Vortr 1900; 97: 1735-1756
    PubMedGoogle Scholar
  • 11 Becker SC, Holstein JH, Pizanis A. et al. Anteriore Zugänge zum Beckenring. Unfallchirurg 2013; 116: 198-204
    CrossrefPubMedGoogle Scholar
  • 12 Marrs C, Blackwell S, Hester A. et al. Pfannenstiel versus vertical skin incision for cesarean delivery in women with class III obesity: a randomized trial. Am J Perinatol 2019; 36: 97-104
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Stoppa R, Petit J, Abourachid H. et al. [Original procedure of groin hernia repair: interposition without fixation of Dacron tulle prosthesis by subperitoneal median approach]. Chirurgie 1973; 99: 119-123
    PubMedGoogle Scholar
  • 14 Ismail HD, Djaja YP, Fiolin J. Minimallly invasive plate osteosynthesis on anterior pelvic ring injury and anterior column acetabular fracture. J Clin Orthop Trauma 2017; 8: 232-240
    CrossrefPubMedGoogle Scholar
  • 15 Meena S, Sharma PK, Mittal S. et al. Modified Stoppa approach versus ilioinguinal approach for anterior acetabular fractures: a systematic review and meta-analysis. Bull Emerg Trauma 2017; 5: 6-12
    PubMedGoogle Scholar
  • 16 Jakob M, Droeser R, Zobrist R. et al. A less invasive anterior intrapelvic approach for the treatment of acetabular fractures and pelvic ring injuries. J Trauma 2006; 60: 1364-1370
    CrossrefPubMedGoogle Scholar
  • 17 Sagi HC, Afsari A, Dziadosz D. The anterior intrapelvic (modified Rives Stoppa) approach for fixation of acetabular fractures. J Orthop Trauma 2010; 24: 263-270
    CrossrefPubMedGoogle Scholar
  • 18 Küper MA, Trulson A, Trulson IM. et al. EASY (endoscopic approach to the symphysis): a new minimally invasive approach for the plate-osteosynthesis of the symphysis and the anterior pelvic ring – a cadaver study and first clinical results. Eur J Trauma Emerg Surg 2019; 45: 745-755
    CrossrefPubMedGoogle Scholar
  • 19 Köckerling F, Bittner R, Jacob DA. et al. TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc 2015; 29: 3750-3760
    CrossrefPubMedGoogle Scholar
  • 20 Köckerling F. Evidence-based TEP technique. Chirurg 2017; 88: 288-295
    CrossrefPubMedGoogle Scholar
  • 21 Guillou PJ, Quirke P, Thorpe H. et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 2005; 365: 1718-1726
    CrossrefPubMedGoogle Scholar
  • 22 Barratt RC, Bernard J, Mundy AR. et al. Pelvic fracture urethral injury in males–mechanisms of injury, management options and outcomes. Transl Androl Urol 2018; 7 (Suppl. 01) S29-S62
    CrossrefPubMedGoogle Scholar
  • 23 Letournel E. Les fractures du cotyle. Étude dʼune série de 75 cas. J Chir (Paris) 1961; 82: 47-87
    PubMedGoogle Scholar
  • 24 Giannoudis PV, Grotz MR, Papakostidis C. et al. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br 2005; 87: 2-9
    CrossrefPubMedGoogle Scholar
  • 25 Do MV, Richardson WS. Lumbar incisional hernia repair after iliac crest bone graft. Ochsner J 2012; 12: 80-81
    PubMedGoogle Scholar
  • 26 Osterhoff G, Ossendorf C, Wanner GA. et al. Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications. Arch Orthop Trauma Surg 2011; 131: 809-813
    CrossrefPubMedGoogle Scholar
  • 27 Dienstknecht T, Berner A, Lenich A. et al. A minimally invasive stabilizing system for dorsal pelvic ring injuries. Clin Orthop Relat Res 2011; 469: 3209-3217
    CrossrefPubMedGoogle Scholar
  • 28 Keel MJ, Ecker TM, Cullmann JL. et al. The pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg Br 2012; 94: 405-411
    CrossrefPubMedGoogle Scholar
  • 29 Keel MJ, Tomagra S, Bonel HM. et al. Clinical results of acetabular fracture management with the pararectus approach. Injury 2014; 45: 1900-1907
    CrossrefPubMedGoogle Scholar
  • 30 Keel MJB, Siebenrock KA, Tannast M. et al. The pararectus approach: a new concept. JBJS Essent Surg Tech 2018; 8: e21
    CrossrefPubMedGoogle Scholar
  • 31 Märdian S, Schaser KD, Hinz P. et al. Fixation of acetabular fractures via the ilioinguinal versus Pararectus approach: a direct comparison. Bone Joint J 2015; 97-B: 1271-1278
    CrossrefPubMedGoogle Scholar
  • 32 Bastian JD, Savic M, Cullmann JL. et al. Surgical exposures and options for instrumentation in acetabular fracture fixation: pararectus approach versus the modified Stoppa. Injury 2016; 47: 695-701
    CrossrefPubMedGoogle Scholar
  • 33 von Langenbeck B. Ueber die Schussverletzungen des Hüftgelenkes. Arch Klin Chir 1874; 16: 263
    PubMedGoogle Scholar
  • 34 Kocher E. Chirurgische Operationslehre. 5. Aufl.. Jena: Fischer; 1907
    Google Scholar
  • 35 Haidukewych GJ, Scaduto J, Herscovici jr. D. et al. Iatrogenic nerve injury in acetabular fracture surgery: a comparison of monitored and unmonitored procedures. J Orthop Trauma 2002; 16: 297-301
    CrossrefPubMedGoogle Scholar
  • 36 Isaack PS, Helfet DL. Sciatic nerve injury associated with acetabular fractures. HSS J 2009; 5: 12-18
    CrossrefPubMedGoogle Scholar
  • 37 Lehmann W, Hoffmann M, Fensky F. et al. What is the frequency of nerve injuries associated with acetabular fractures?. Clin Orthop Relat Res 2014; 472: 3395-3403
    CrossrefPubMedGoogle Scholar