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Subinguinal approach to pelvis and acetabulum

Hamid Reza Seyyed Hosseinzadeh MD, Farivar Bagheri MD, Mehrnoush Hassas Yeganeh MD*

Shahid Beheshti University of Medical Sciences, Tehran, Iran
* Corresponding Author

The ilioinguinal approach is the approach of choice in the fractures of anterior part of pelvis especially in the region of pubic ramus, but there are some technical difficulties which may result in inguinal herniation or inguinal ligament injury and it provides a limited exposure. Therefore, it is not suitable in some complex fractures. In 2008, a modified ilioinguinal approach was introduced in our department which provided a complete view of the inside and outside of the pelvis.

The approach involves retroperitoneal access below the inguinal ligament to preserve the integrity of the inguinal canal and allows exposure of anterior and medial wall fractures as well as the anterior hip capsule. Despite the dimensions of the procedure, closure is anatomical because repair of the inguinal canal floor is not required. We report again the use of this approach in 45 patients with transverse and T-type fractures of the acetabulum, Tile C1 and C2 pelvic fractures, malunion of the pelvis, acetabular dysplasia and pelvic tumor resection. The approach is recommended in complex cases of acetabular surgery (including obese or muscular patients) and complicated or old fractures in which a better exposure is required. It is useful in visualization of the anterior wall and labrum and intra articular structures, and in viewing the internal anatomy of the pelvis and acetabulum. It proved to be suitable for periacetabular osteotomy.

Keywords: Ilioinguinal approach, Subinguinal, Retroperitoneal, Acetabular fracture, Anterior wall