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Review Question - QID 1198

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QID 1198 (Type "1198" in App Search)
A 45-year-old male is involved in a motor vehicle accident and sustains the injury shown in Figures A-D. Which of the following is the most appropriate approach for surgical fixation of this fracture?
  • A
  • B
  • C
  • D

Ilioinguinal

2%

61/2465

Kocher-Langenbeck

87%

2155/2465

Stoppa

3%

67/2465

Stoppa with lateral window

4%

105/2465

Extended iliofemoral

3%

65/2465

  • A
  • B
  • C
  • D

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The images demonstrate a posterior column acetabular fracture. These are best surgically treated with a Kocher-Langenbeck approach, which allows access to the posterior column and posterior wall. Figure A shows disruption of the ilioischial line with an intact iliopectineal line which is diagnostic of this fracture pattern. The CT image in Figure D shows the characteristic horizontal (coronal) orientation of the column fracture when viewed on an axial CT. Illustration A shows the radiographic landmarks used in diagnosing acetabular fractures. Illustrations B and C show the orientation of column and wall fractures respectively. Ilioinguinal and Stoppa approaches allow access for anterior column fixation and symphysis fixation respectively. The extended iliofemoral approach can be used to treat both column injuries, but has high rates of post-operative heterotopic ossification.

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