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Multiple surgical approaches exist for the operative treatment of acetabular fractures. The extended iliofemoral and triradiate approaches are extensile and provide simultaneous access to the anterior and posterior column, as well as direct visualization of the articular surface.1--7 Although they provide excellent exposure, these approaches are associated with higher complication rates, including heterotopic ossification.2,8--18 The triradiate incision has been associated with a high rate of wound complications.3,19
At the senior author's (L.E.D.) institution, the triradiate transtrochanteric approach was initially used in the treatment of all acetabular fractures. Realizing the rare need for the inferior limb of this incision to achieve adequate exposure, he stopped using this portion of the incision. The resultant incision was U-shaped. Ollier20 previously described this approach, and modifications of the Ollier approach were described for the treatment of acetabular fractures, as well as for periacetabular osteotomies for dysplastic hips.6,21
We hypothesized that the rates of wound and neurologic complications and clinically significant heterotopic ossification (Brooker stage 3 and 4) with the modified Ollier transtrochanteric approach would be no higher than with other surgical approaches reported in large series.9
Materials and Methods
After obtaining Institutional Review Board approval, a retrospective review was performed of a consecutive series of patients who underwent open reduction and internal fixation (ORIF) of an acetabular fracture by a single surgeon (L.E.D.). This review identified 94 patients (95 acetabuli) who underwent operative fixation via a modified Ollier transtrochanteric approach between January 1994 and December 2003.
Ninety-four patients (95 acetabuli) had charts available for review, including 69 men and 25 women with a mean age of 36 years. Minimum follow-up was 3 months, with an average of 9 months of follow-up for the series. Forty-two patients fractured the right acetabulum, and 53 patients fractured the left acetabulum. The stratification of the different fracture types, classified according to Judet et al,22 is listed in Table 1. All patients, regardless of fracture type, were treated using the modified Ollier approach at the discretion of the senior author.
Fifty-one (54%) patients had concomitant extremity fractures at injury. Twelve (13%) patients also sustained head injuries. Mean time from injury to operative fixation was 7 days. Mean surgical time for ORIF was 170 minutes, with a mean...