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Review Question - QID 1382

QID 1382 (Type "1382" in App Search)
The approach shown in Figure A is most indicated for which of the following acute fracture patterns?
  • A

Comminuted posterior wall fracture



Posterior wall and posterior column fracture



Transtectal transverse fracture with impacted roof



Anterior column and posterior hemitransverse fracture



Simple posterior wall fracture



  • A

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Figure A outlines the surgical incision for the extended iliofemoral approach. This approach was developed by Emile Letournel as a simultaneous approach to both columns of the acetabulum. This approach exposes the entire lateral innominate bone by posterior reflection of the abductors and reflection of short external rotators. It can be extended anteriorly into the first iliac window of the ilioinguinal incision if needed. Indications for this approach include: transverse and T-type fractures with posterior wall involvement or an impacted roof, both-column fractures with posterior wall or posterior column comminution, sacroiliac joint involvement, and transverse fractures more than three weeks old. Disadvantages of this approach include: significant stripping of the bone which can lead to heterotopic bone formation, and prolonged abductor weakness and recovery period. The incision starts at the posterosuperior iliac spine, follows the iliac crest to the anterosuperior spine, and then turns slightly lateral to parallel the femur on the anterolateral aspect of the thigh.

Judet et al review 129 surgically treated acetabular fractures and describe mechanism of injury, radiographic findings, and options for treatment.

Answer choices 1,2, and 5 are typically treated through a Kocher-Langenbeck approach. Answer choice 4 is usually treated through an ilioinguinal approach.

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