TECHNICAL TRICK
Osteotomy of the Anterior Superior Iliac Spine as an Adjunct to Improve Access and Visualization Through the Lateral Window H. Claude Sagi, MD* and Brett Bolhofner, MD†
Summary: The lateral “window” has previously been described as part of the ilioinguinal and anterior intrapelvic approaches for gaining access to the anterior aspect of the sacroiliac joint, the internal iliac fossa, and upper portion of the anterior column for reduction and placement of fixation. Surgical exposure of this window typically involves release of the external oblique muscle from the iliac crest and elevation of the iliacus muscle from the internal iliac fossa. This exposure is limited by the residual attachment of the external oblique muscle and inguinal ligament to the anterior superior iliac spine, particularly in patients with a large abdomen or in fractures that involve the anterior wall of the acetabulum and pubic root region. Herein, we describe the addition of an osteotomy of the anterior superior iliac spine for improved medial mobilization of the abdominal wall musculature to allow better visualization and access to the internal iliac fossa and anterior aspect of the sacroiliac joint. Key Words: ASIS, osteotomy, lateral window (J Orthop Trauma 2015;29:e266–e269)
TECHNIQUE DESCRIPTION The patient is positioned supine on the operating table with the ipsilateral extremity free draped and flexed at the hip and knee. The surgical field should include draping up to the lower aspect of the rib cage. From posterior to anterior, the incision runs along the iliac crest until the anterior superior iliac spine (ASIS) where it curves distally for approximately 4 cm (Fig. 1). The lateral window is opened in the usual manner by finding the interval between the external oblique and tensor fascia muscles, then elevating and releasing the external oblique off of the iliac crest. Remember that the external oblique “hangs” over the crest inferiorly and must be pulled proximally to properly develop this interval and avoid cutting through the muscle directly down to the crest. As the external oblique Accepted for publication December 8, 2014. From the *Department of Orthopedic Surgery, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and †Department of Orthopedic Surgery, Bayfront Medical Center, St. Petersburg, FL. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions this article on the journal’s Web site (www.jorthotrauma.com). Reprints: H. Claude Sagi, MD, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, Suite 710, Tampa, FL 33606 (e-mail: [email protected]). Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
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| www.jorthotrauma.com
muscle insertion is sharply released from the crest down toward the internal iliac fossa, the fibers of the iliacus muscle will come into view, and at this point, a periosteal elevator can be used to elevate the iliacus muscle away from the internal iliac fossa to expose the upper portion of the anterior column, pelvic brim, and anterior aspect of the sacroiliac joint (SJ). Medial retraction of the abdominal wall and contents is facilitated by placing malleable or Holman retractors (1) over the posterior iliac crest, (2) medial to the pelvic brim, and (3) onto the ala of the sacrum lateral to the L5 nerve root. Visualization and exposure for the placement of reduction clamps or fixation will, at times, be suboptimal secondary to the patient’s body habitus, individual anatomic variations, or the location of the fracture. An osteotomy of the ASIS is then performed to improve the access and maximize medial retraction of the abdominal wall and contents. The ASIS osteotomy for the lateral window is a digastric osteotomy; the external oblique muscle superiorly and the sartorius muscle inferiorly remain attached to the ASIS and provide opposing forces on the subsequent repair, which helps to mitigate the risk of displacement and nonunion. The anterior 2 cm of external oblique insertion at the ASIS is left intact. In contradistinction to the usual exposure for the lateral window where the external oblique insertion would be released all the way to the ASIS, the surgeon should have some predetermined idea that the osteotomy will be performed so that a sufficient amount of external oblique insertion will remain on the iliac crest and ASIS, thus preserving the proximal portion of the “digastric” nature of this osteotomy. The fascia overlying the sartorius and tensor fascia is incised and the interval between the 2 muscles is developed after the lateral femoral cutaneous nerve (LFCN) is identified, dissected, and protected (see Figure, Supplemental Digital Content 1, http://links.lww.com/BOT/A416). The most anterior extent of the tensor fascia muscle origin needs to be elevated from the lateral aspect of the anterior ilium so that the surgeon can palpate the small valley between the ASIS and the anterior inferior iliac spine above the origin of the rectus femoris. Although some surgeons may prefer to predrill the lag screw for later repair before performing the osteotomy, the authors do not perform this maneuver. A curved ½00 osteotome is then used to perform the osteotomy along a line starting 2 cm posterior to the ASIS and terminating in the groove between the ASIS and anterior inferior iliac spine (see Figure, Supplemental Digital Content 2, http://links.lww.com/BOT/A417). The ASIS along J Orthop Trauma Volume 29, Number 8, August 2015
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
J Orthop Trauma Volume 29, Number 8, August 2015
FIGURE 1. Incision for lateral window with distal vertical extension at the ASIS to accommodate the osteotomy and dissection of the LFCN.
with the sartorius and external oblique is retracted medially to further expose the pubic root (lateral extent of the superior pubic ramus just medial to the base of the anterior acetabular wall), psoas gutter, and pelvic brim back to the SJ. The added medial retraction of the abdominal wall and contents significantly enhances the visibility and working space when accessing these structures, in addition to improving access for placing offset reduction clamps over the brim onto the quadrilateral surface (particularly in obese patients). Figures 2 and 3 demonstrate the difference in visualization of the internal iliac fossa of the same patient with and without the ASIS osteotomy. In the authors’ opinion, the ASIS osteotomy provides the added benefits of improved exposure of the anterior acetabular wall without requiring dissection of the inguinal canal and protection of the LFCN (avoiding iatrogenic postoperative
Osteotomy of the Anterior Superior Iliac Spine
FIGURE 3. Visualization through the lateral window before ASIS osteotomy.
nerve palsy) through release from the tensor fascia and medial retraction with the sartorius, external oblique, and ASIS. The osteotomy is repaired using a single 3.5-mm lag screw placed from the ASIS retrograde along the iliac crest to gain purchase in the iliac tubercle. No specific postoperative restrictions are used with respect to protecting the repair of the osteotomy.
CLINICAL SERIES Cases were performed at one level 1 and one level 2 regional trauma center from January 2012 to June 2014 by 2 fellowship-trained orthopaedic trauma surgeons. The osteotomy was incorporated into the surgical exposure as an adjunct to the anterior intrapelvic (AIP) approach for 30 acetabular fractures (18 associated both column pattern and 12 anterior column posterior hemitransverse acetabular fractures—Figure 4; and see Figure, Supplemental Digital Content 3, http://links.lww.com/BOT/A279), 10 anterior open reductions of the SJ (Fig. 5; and see Figure, Supplemental Digital Content 4, http://links.lww.com/BOT/A280), and 2 anterior open reductions of the posterior ring to include an iliac wing fracture. Postoperative follow-up ranged from 3 months to 2 years (average). At final follow-up, there were no nonunions of the osteotomy, no fixation failures, and no permanent LFCN palsies reported.
DISCUSSION
FIGURE 2. Medial retraction of the external oblique and iliacus after ASIS osteotomy with visualization of the pubic root, pelvic brim, and anterior SI joint. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Anterior approaches to the acetabulum or SJ will commonly use a lateral “window” that gives access to the iliac crest and internal iliac fossa by releasing the external oblique and elevating the iliacus muscle. Not uncommonly, access may be restricted because of a large abdominal girth and the fact that the external oblique muscle remains attached to the ASIS, both of which limit the amount that the abdominal wall can be retracted medially. To improve visualization, www.jorthotrauma.com |
e267
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Sagi and Bolhofner
FIGURE 4. Iliac projection of an acetabular fracture fixation using the ASIS osteotomy.
further medial retraction of the abdominal wall and iliopsoas can be facilitated by osteotomy of the ASIS. In 1917 and 1949, Smith-Peterson described an anterior approach to the hip joint for pelvic osteotomy and arthroplasty.1,2 The approach used an incision along the iliac crest extending vertically and distally at the ASIS to allow for an internervous plane of dissection between the sartorius and tensor fascia superficially, and between the rectus femoris and gluteus medius more deeply. This approach, commonly referred to as the iliofemoral approach, involved elevation of the abductors and tensor fascia from the outer table of the ilium. Subsequently in 1967, Judet et al3 described the Ilioinguinal as a novel anterior approach to the acetabulum. The lateral “window” of this approach used an incision along the iliac crest as well; however, the external oblique is elevated from the iliac
J Orthop Trauma Volume 29, Number 8, August 2015
crest to allow access into the false pelvis and internal iliac fossa. In 1987, Simpson et al4 reported on their use of the lateral window—as described by Judet and Letournel—to gain access to the anterior aspect of the posterior pelvic ring for reduction and fixation of SI joint dislocations. More recently, modifications to the traditional surgical exposures to the acetabulum and pelvis have evolved to address various difficulties encountered with exposure and placement of reduction clamps or fixation. The AIP approach (or modified Stoppa) has gained increased utility as a useful approach to the anterior pelvic ring and acetabulum.5,6 This approach does not open the middle or second window of the classic ilioinguinal approach as described by Letournel. Because the middle window is not used, the surgical exposure of the AIP relies heavily on good visualization from the medial window and, when required based on fracture characteristics, the lateral window. Techniques to improve visualization from the AIP have been previously published,7 but limitations of the lateral window exposure have persisted because of the residual attachment of the external oblique muscle to the ASIS limiting the surgeon’s ability to adequately retract the abdominal wall and contents medially. In 2012, Sen et al8 reported on an alternative technique for placing anterior column screws around the acetabulum. In this article, the authors detail the technique for screw placement, but only briefly mention an osteotomy of the ASIS to improve visualization for placement of their anterior column screw, which at some point in its trajectory, is extraosseous and near the femoral vascular bundle. They do not elaborate on the technique for osteotomy, fixation of the ASIS, or any of the potential complications including palsy of the LFCN. Osteotomy of the ASIS has proved to be a useful adjunct to increase visualization when using the lateral window for exposure, reduction, and fixation of the SJ and acetabulum when an anterior approach is desired. Additionally (in the authors’ opinion), it mitigates the potential for iatrogenic injury to the LFCN. Dissection and release of the LFCN from the tensor fascia allow medial retraction of the nerve as the external oblique and sartorius are retracted medially with the ASIS, thus minimizing tension and ischemia within the nerve.9 Indeed, the reported incidence of permanent LFCN palsy after ASIS osteotomy for acetabular fracture surgery (0%) is substantially lower than that reported following anterior approaches for total hip arthroplasty and pelvic osteotomy.9,10 In conclusion, we believe that an osteotomy of the ASIS to improve access when using the lateral window for exposure of the anterior SJ or acetabulum not only improves visualization but decreased the potential for iatrogenic injury to the LFCN. REFERENCES
FIGURE 5. AP pelvis projection of an anterior approach and fixation of the SJ using the ASIS osteotomy.
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| www.jorthotrauma.com
1. Smith-Petersen MN. A new supra-articular subperiosteal approach to the hip. Am J Orthop Surg. 1917;15:592. 2. Smith-Petersen MN. Approach to and exposure of the hip joint for arthroplasty. J Bone Joint Surg Am. 1949;31:40–46. 3. Judet R, Judet J, Letournel E. Surgical treatment of recent fractures of the acetabulum. (Apropos of 46 operated cases) [in French]. Mem Acad Chir (Paris). 1962;88:369–377. 4. Simpson LA, Waddell JP, Leighton RK, et al. Anterior approach and stabilization of the disrupted sacroiliac joint. J Trauma. 1987;27:1332–1338.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
J Orthop Trauma Volume 29, Number 8, August 2015 5. Hirvensalo E, Lindahl J, Böstman O. A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res. 1993;297: 28–32. 6. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994;305:112–123. 7. Sagi HC, Afsari A, Dziadosz D. The anterior intra-pelvic (modified rivesstoppa) approach for fixation of acetabular fractures. J Orthop Trauma. 2010;24:263–270.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Osteotomy of the Anterior Superior Iliac Spine 8. Sen RK, Tripathy SK, Aggarwal S, et al. A safe technique of anterior column lag screw fixation in acetabular fractures. Int Orthop. 2012;3611: 2333–2340. 9. Kiyama T, Naito M, Shiramizu K, et al. Ischemia of the lateral femoral cutaneous nerve during periacetabular osteotomy using Smith-Petersen approach. J Orthop Traumatol. 2009;10:123–126. 10. Goulding K, Beaulé PE, Kim PR, et al. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res. 2010;468:2397–2404.
www.jorthotrauma.com |
e269
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Osteotomy of the Anterior Superior Iliac Spine as an Adjunct to Improve Access and Visualization Through the Lateral Window H. Claude Sagi, MD* and Brett Bolhofner, MD†
Summary: The lateral “window” has previously been described as part of the ilioinguinal and anterior intrapelvic approaches for gaining access to the anterior aspect of the sacroiliac joint, the internal iliac fossa, and upper portion of the anterior column for reduction and placement of fixation. Surgical exposure of this window typically involves release of the external oblique muscle from the iliac crest and elevation of the iliacus muscle from the internal iliac fossa. This exposure is limited by the residual attachment of the external oblique muscle and inguinal ligament to the anterior superior iliac spine, particularly in patients with a large abdomen or in fractures that involve the anterior wall of the acetabulum and pubic root region. Herein, we describe the addition of an osteotomy of the anterior superior iliac spine for improved medial mobilization of the abdominal wall musculature to allow better visualization and access to the internal iliac fossa and anterior aspect of the sacroiliac joint. Key Words: ASIS, osteotomy, lateral window (J Orthop Trauma 2015;29:e266–e269)
TECHNIQUE DESCRIPTION The patient is positioned supine on the operating table with the ipsilateral extremity free draped and flexed at the hip and knee. The surgical field should include draping up to the lower aspect of the rib cage. From posterior to anterior, the incision runs along the iliac crest until the anterior superior iliac spine (ASIS) where it curves distally for approximately 4 cm (Fig. 1). The lateral window is opened in the usual manner by finding the interval between the external oblique and tensor fascia muscles, then elevating and releasing the external oblique off of the iliac crest. Remember that the external oblique “hangs” over the crest inferiorly and must be pulled proximally to properly develop this interval and avoid cutting through the muscle directly down to the crest. As the external oblique Accepted for publication December 8, 2014. From the *Department of Orthopedic Surgery, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and †Department of Orthopedic Surgery, Bayfront Medical Center, St. Petersburg, FL. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions this article on the journal’s Web site (www.jorthotrauma.com). Reprints: H. Claude Sagi, MD, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, Suite 710, Tampa, FL 33606 (e-mail: [email protected]). Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
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| www.jorthotrauma.com
muscle insertion is sharply released from the crest down toward the internal iliac fossa, the fibers of the iliacus muscle will come into view, and at this point, a periosteal elevator can be used to elevate the iliacus muscle away from the internal iliac fossa to expose the upper portion of the anterior column, pelvic brim, and anterior aspect of the sacroiliac joint (SJ). Medial retraction of the abdominal wall and contents is facilitated by placing malleable or Holman retractors (1) over the posterior iliac crest, (2) medial to the pelvic brim, and (3) onto the ala of the sacrum lateral to the L5 nerve root. Visualization and exposure for the placement of reduction clamps or fixation will, at times, be suboptimal secondary to the patient’s body habitus, individual anatomic variations, or the location of the fracture. An osteotomy of the ASIS is then performed to improve the access and maximize medial retraction of the abdominal wall and contents. The ASIS osteotomy for the lateral window is a digastric osteotomy; the external oblique muscle superiorly and the sartorius muscle inferiorly remain attached to the ASIS and provide opposing forces on the subsequent repair, which helps to mitigate the risk of displacement and nonunion. The anterior 2 cm of external oblique insertion at the ASIS is left intact. In contradistinction to the usual exposure for the lateral window where the external oblique insertion would be released all the way to the ASIS, the surgeon should have some predetermined idea that the osteotomy will be performed so that a sufficient amount of external oblique insertion will remain on the iliac crest and ASIS, thus preserving the proximal portion of the “digastric” nature of this osteotomy. The fascia overlying the sartorius and tensor fascia is incised and the interval between the 2 muscles is developed after the lateral femoral cutaneous nerve (LFCN) is identified, dissected, and protected (see Figure, Supplemental Digital Content 1, http://links.lww.com/BOT/A416). The most anterior extent of the tensor fascia muscle origin needs to be elevated from the lateral aspect of the anterior ilium so that the surgeon can palpate the small valley between the ASIS and the anterior inferior iliac spine above the origin of the rectus femoris. Although some surgeons may prefer to predrill the lag screw for later repair before performing the osteotomy, the authors do not perform this maneuver. A curved ½00 osteotome is then used to perform the osteotomy along a line starting 2 cm posterior to the ASIS and terminating in the groove between the ASIS and anterior inferior iliac spine (see Figure, Supplemental Digital Content 2, http://links.lww.com/BOT/A417). The ASIS along J Orthop Trauma Volume 29, Number 8, August 2015
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
J Orthop Trauma Volume 29, Number 8, August 2015
FIGURE 1. Incision for lateral window with distal vertical extension at the ASIS to accommodate the osteotomy and dissection of the LFCN.
with the sartorius and external oblique is retracted medially to further expose the pubic root (lateral extent of the superior pubic ramus just medial to the base of the anterior acetabular wall), psoas gutter, and pelvic brim back to the SJ. The added medial retraction of the abdominal wall and contents significantly enhances the visibility and working space when accessing these structures, in addition to improving access for placing offset reduction clamps over the brim onto the quadrilateral surface (particularly in obese patients). Figures 2 and 3 demonstrate the difference in visualization of the internal iliac fossa of the same patient with and without the ASIS osteotomy. In the authors’ opinion, the ASIS osteotomy provides the added benefits of improved exposure of the anterior acetabular wall without requiring dissection of the inguinal canal and protection of the LFCN (avoiding iatrogenic postoperative
Osteotomy of the Anterior Superior Iliac Spine
FIGURE 3. Visualization through the lateral window before ASIS osteotomy.
nerve palsy) through release from the tensor fascia and medial retraction with the sartorius, external oblique, and ASIS. The osteotomy is repaired using a single 3.5-mm lag screw placed from the ASIS retrograde along the iliac crest to gain purchase in the iliac tubercle. No specific postoperative restrictions are used with respect to protecting the repair of the osteotomy.
CLINICAL SERIES Cases were performed at one level 1 and one level 2 regional trauma center from January 2012 to June 2014 by 2 fellowship-trained orthopaedic trauma surgeons. The osteotomy was incorporated into the surgical exposure as an adjunct to the anterior intrapelvic (AIP) approach for 30 acetabular fractures (18 associated both column pattern and 12 anterior column posterior hemitransverse acetabular fractures—Figure 4; and see Figure, Supplemental Digital Content 3, http://links.lww.com/BOT/A279), 10 anterior open reductions of the SJ (Fig. 5; and see Figure, Supplemental Digital Content 4, http://links.lww.com/BOT/A280), and 2 anterior open reductions of the posterior ring to include an iliac wing fracture. Postoperative follow-up ranged from 3 months to 2 years (average). At final follow-up, there were no nonunions of the osteotomy, no fixation failures, and no permanent LFCN palsies reported.
DISCUSSION
FIGURE 2. Medial retraction of the external oblique and iliacus after ASIS osteotomy with visualization of the pubic root, pelvic brim, and anterior SI joint. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Anterior approaches to the acetabulum or SJ will commonly use a lateral “window” that gives access to the iliac crest and internal iliac fossa by releasing the external oblique and elevating the iliacus muscle. Not uncommonly, access may be restricted because of a large abdominal girth and the fact that the external oblique muscle remains attached to the ASIS, both of which limit the amount that the abdominal wall can be retracted medially. To improve visualization, www.jorthotrauma.com |
e267
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Sagi and Bolhofner
FIGURE 4. Iliac projection of an acetabular fracture fixation using the ASIS osteotomy.
further medial retraction of the abdominal wall and iliopsoas can be facilitated by osteotomy of the ASIS. In 1917 and 1949, Smith-Peterson described an anterior approach to the hip joint for pelvic osteotomy and arthroplasty.1,2 The approach used an incision along the iliac crest extending vertically and distally at the ASIS to allow for an internervous plane of dissection between the sartorius and tensor fascia superficially, and between the rectus femoris and gluteus medius more deeply. This approach, commonly referred to as the iliofemoral approach, involved elevation of the abductors and tensor fascia from the outer table of the ilium. Subsequently in 1967, Judet et al3 described the Ilioinguinal as a novel anterior approach to the acetabulum. The lateral “window” of this approach used an incision along the iliac crest as well; however, the external oblique is elevated from the iliac
J Orthop Trauma Volume 29, Number 8, August 2015
crest to allow access into the false pelvis and internal iliac fossa. In 1987, Simpson et al4 reported on their use of the lateral window—as described by Judet and Letournel—to gain access to the anterior aspect of the posterior pelvic ring for reduction and fixation of SI joint dislocations. More recently, modifications to the traditional surgical exposures to the acetabulum and pelvis have evolved to address various difficulties encountered with exposure and placement of reduction clamps or fixation. The AIP approach (or modified Stoppa) has gained increased utility as a useful approach to the anterior pelvic ring and acetabulum.5,6 This approach does not open the middle or second window of the classic ilioinguinal approach as described by Letournel. Because the middle window is not used, the surgical exposure of the AIP relies heavily on good visualization from the medial window and, when required based on fracture characteristics, the lateral window. Techniques to improve visualization from the AIP have been previously published,7 but limitations of the lateral window exposure have persisted because of the residual attachment of the external oblique muscle to the ASIS limiting the surgeon’s ability to adequately retract the abdominal wall and contents medially. In 2012, Sen et al8 reported on an alternative technique for placing anterior column screws around the acetabulum. In this article, the authors detail the technique for screw placement, but only briefly mention an osteotomy of the ASIS to improve visualization for placement of their anterior column screw, which at some point in its trajectory, is extraosseous and near the femoral vascular bundle. They do not elaborate on the technique for osteotomy, fixation of the ASIS, or any of the potential complications including palsy of the LFCN. Osteotomy of the ASIS has proved to be a useful adjunct to increase visualization when using the lateral window for exposure, reduction, and fixation of the SJ and acetabulum when an anterior approach is desired. Additionally (in the authors’ opinion), it mitigates the potential for iatrogenic injury to the LFCN. Dissection and release of the LFCN from the tensor fascia allow medial retraction of the nerve as the external oblique and sartorius are retracted medially with the ASIS, thus minimizing tension and ischemia within the nerve.9 Indeed, the reported incidence of permanent LFCN palsy after ASIS osteotomy for acetabular fracture surgery (0%) is substantially lower than that reported following anterior approaches for total hip arthroplasty and pelvic osteotomy.9,10 In conclusion, we believe that an osteotomy of the ASIS to improve access when using the lateral window for exposure of the anterior SJ or acetabulum not only improves visualization but decreased the potential for iatrogenic injury to the LFCN. REFERENCES
FIGURE 5. AP pelvis projection of an anterior approach and fixation of the SJ using the ASIS osteotomy.
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| www.jorthotrauma.com
1. Smith-Petersen MN. A new supra-articular subperiosteal approach to the hip. Am J Orthop Surg. 1917;15:592. 2. Smith-Petersen MN. Approach to and exposure of the hip joint for arthroplasty. J Bone Joint Surg Am. 1949;31:40–46. 3. Judet R, Judet J, Letournel E. Surgical treatment of recent fractures of the acetabulum. (Apropos of 46 operated cases) [in French]. Mem Acad Chir (Paris). 1962;88:369–377. 4. Simpson LA, Waddell JP, Leighton RK, et al. Anterior approach and stabilization of the disrupted sacroiliac joint. J Trauma. 1987;27:1332–1338.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
J Orthop Trauma Volume 29, Number 8, August 2015 5. Hirvensalo E, Lindahl J, Böstman O. A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res. 1993;297: 28–32. 6. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res. 1994;305:112–123. 7. Sagi HC, Afsari A, Dziadosz D. The anterior intra-pelvic (modified rivesstoppa) approach for fixation of acetabular fractures. J Orthop Trauma. 2010;24:263–270.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Osteotomy of the Anterior Superior Iliac Spine 8. Sen RK, Tripathy SK, Aggarwal S, et al. A safe technique of anterior column lag screw fixation in acetabular fractures. Int Orthop. 2012;3611: 2333–2340. 9. Kiyama T, Naito M, Shiramizu K, et al. Ischemia of the lateral femoral cutaneous nerve during periacetabular osteotomy using Smith-Petersen approach. J Orthop Traumatol. 2009;10:123–126. 10. Goulding K, Beaulé PE, Kim PR, et al. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res. 2010;468:2397–2404.
www.jorthotrauma.com |
e269
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
