SMW Supplementum 193 - Swiss Medical Weekly

23 S SWiSS Med Wkly 2012;142(Suppl 193) · www.smw.ch Free communications
Conclusion: Dorsal double locking plate fixation of the sacral
component by open approach and direct reduction is a successful and
save alternative to percutaneous iliosacral screw fixation in pelvic
C-type fractures. The risk of iatrogenic nerve injury seems to be low
even in Denis II type fractures. The open approach enables a good
quality of reduction especially in severely displaced fractures.
FM87
The Pararectus approach for anterior intrapelvic
management of acetabular fractures
Johannes Dominik Bastian1 , Timo M Ecker1 , Jennifer L Cullmann-
Bastian2 , Harald M Bonel2 , Lorenz Büchler1 , Klaus Arno Siebenrock1 ,
Marius Johann Baptist Keel1 1Department of Orthopaedic and Trauma Surgery, University of Bern,
Inselspital, Bern; 2Department of Diagnostic Interventional and
Paediatric Radiology, University of Bern, Inselspital, Bern
Introduction: A new anterior intrapelvic approach for treatment of
displaced acetabular fractures involving predominantly the anterior
column and the quadrilateral surface is introduced. To establish five
“windows” for instrumentation, the extraperitoneal space is entered
along the lateral border of the rectus abdominis muscle, the so-called
“Pararectus” approach.
Methods: The feasibility of secure dissection and optimal
instrumentation of the pelvis was assessed in five human cadavers
(ten hemipelves) before its implementation in a consecutive series in
twenty patients (mean age 59 years, range: 17–90; 17 male) between
12/2009 and 12/2010. The quality of reduction using CT scans and the
occurrence of intraoperative complications were assessed.
Results: In cadavers, sufficient extraperitoneal access and secure
instrumentation of the pelvis were accomplished. In patients, reduction
of fracture displacement was statistically significant [pre- vs.
postoperative (mean ± SD): step-off: 3.3 ± 2.6 mm vs. 0.1 ± 0.3 mm,
p