By combining all these factors, it is possible to successfully treat these fractures, minimizing complications and morbidity. In addition to these factors there are several techniques that facilitate reduction such as distraction and reduction forceps and reduction manoeuvres (hip mobilization and ligamentotaxis with lower limb traction). Its success depends on various factors: surgical timing (the earlier the surgery, the easier the reduction), selection of the approach (precise characterization of the type and location of the fractures) and operative planning (sequence of reduction and fixation: which fractures to reduce and fix first). Sometimes it is necessary to perform combined approaches (anterior and posterior) which makes the surgery more complex and with greater morbidity.Īnother decisive factor in the success of the osteosynthesis of these fractures is their reduction. In this, a curvilinear incision is made in the gluteal region with the proximal part following the direction of the fibres of the large gluteal muscle and distally the direction of the femur. Of the posterior approaches, the most used is the Kocher-Lagenbeck route (posterior wall and column). In the modified Stoppa approach, two 10 cm incisions are made, one in the anterior abdominal (Pfannenstiel) and the other on the iliac crest. In the ilio-inguinal approach, the incision is made in the inguinal region (groin) and is usually about 15 cm long. The most commonly used anterior approaches are the ilio-inguinal (wall and anterior column of the acetabulum pubis) and the modified Stoppa, which, besides allowing fixation of anterior fractures, allows access to the pubic symphysis and to the quadrilateral lamina (acetabular fundus). Generically, we can divide them into anterior or intra-pelvic approaches and posterior or extra-pelvic approaches. The surgical approach must be carefully selected based on the type and location of the fracture and according to the operative plan for its reduction. The plates may already have specific shapes (pre-moulded) or be moulded and cut at the time of surgery to better adapt to the site and type of fracture.īut before the final fixation of these fractures, there are two decisive moments: the surgical approach and the fracture reduction (placing the fractures in place and aligned). Osteosynthesis or surgical fixation of this type of fracture is complex, laborious (long surgeries) and not without risk due to the proximity of important anatomical structures (lumbar nerve roots and sciatic and femoral nerve, iliac and femoral blood vessels, intra-pelvic organs), so they must be performed by specialists in pelvic and hip trauma.
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