High Yield Overview

ACETABULAR FRACTURE ORIF - ANTERIOR COLUMN

Ilioinguinal Approach (Three-Window Technique) | Advanced Pelvic Trauma

Indications

Indications and Contraindications

Displaced anterior column fractures with >2mm articular step-off through weight-bearing dome
Pelvic brim displacement >5mm compromising hip stability
Anterior column + posterior hemitransverse fracture patterns
Both-column fractures requiring anterior approach for reduction
T-type fractures with significant anterior component displacement
Associated hip dislocation not reducible by closed means
Incarcerated intra-articular fragments from femoral head impaction

Exam Pearl

Examiner Question: "How do you determine if the weight-bearing dome is involved?"

Model Answer: "I use Matta's roof arc measurements. On AP and both oblique views, I draw a vertical line through the femoral head center, then measure the angle from this line to where the fracture exits the articular surface. If ANY of the three roof arc angles is less than 45°, the weight-bearing dome is involved and surgery is indicated. Additionally, on CT, I look at cuts through the dome - the superior 10mm of acetabulum carries 90% of load."

Indication Pitfalls

Measuring roof arcs incorrectly - must be from vertical line through head center
Missing dome impaction on plain films - CT essential to see marginal impaction
Underestimating posterior wall - if >40% involved, add posterior approach
Ignoring quadrilateral plate - medial displacement predicts instability

Pre-operative Planning

Pre-operative Assessment

Clinical Assessment

History

Mechanism: high-energy (MVA, fall from height) vs low-energy (elderly)
Time since injury (optimal surgery 3-7 days)
Associated injuries: urological, vascular, neurological
Comorbidities: anticoagulation, diabetes, smoking, immunosuppression
Functional baseline and expectations

Examination

Neurovascular: femoral, sciatic nerve function documented
Skin: Morel-Lavallée lesion (degloving), abrasions, open wounds
Associated injuries: chest, spine, long bone fractures
Ipsilateral limb: leg length, rotation, stability
Urological: blood at meatus, high-riding prostate, perineal bruising

Imaging Review

Essential Imaging

Exam Pearl

Matta Roof Arc Measurements: Draw vertical/horizontal lines through femoral head center on AP and obliques. Measure angle from fracture to weight-bearing dome. If ALL three arcs >45°, non-operative management may be considered.

Templating and Planning

Fracture classification: Judet-Letournel (elementary vs associated)
Approach selection: Ilioinguinal for anterior column, Kocher-Langenbeck for posterior
Plate selection: 3.5mm reconstruction plates, pre-contoured pelvic brim plates
Screw lengths: Template from CT (typically 30-50mm pelvic brim, 20-35mm quadrilateral)
Blood products: Type and screen, have 2-4 units PRBC available

Consent Discussion

Expected Outcomes:

Anatomic reduction (<2mm): 85-90% good/excellent clinical outcome
Non-anatomic reduction: 50% poor outcome
20-30% eventual THA conversion at 10-15 years despite good reduction

Specific Risks to Discuss:

Complication	Incidence	Key Points
LFCN injury	70%	Usually temporary numbness anterolateral thigh
Femoral nerve	1-3%	Usually neuropraxia, recovers 6-12 months
Vascular injury	<1%	External iliac - catastrophic if occurs
Corona mortis bleed	5-10%	Ligate prophylactically
DVT/PE	5-10%	Extended prophylaxis required
Infection	2-3% superficial, <1% deep	Higher with Morel-Lavallée
Heterotopic ossification	20-50%	Prophylaxis reduces to 5-10%
Post-traumatic arthritis	20-30%	Despite anatomic reduction
Nonunion	~5%	Higher with comminution

Equipment

Required Equipment

Implants

3.5mm pelvic reconstruction plates (multiple lengths: 6-14 hole)
Pre-contoured pelvic brim plates (if available)
3.5mm cortical screws (lengths 20-60mm)
3.5mm cancellous screws (for lag technique)
4.5mm cortical screws (for iliac wing if needed)
Spring plates for comminution
2.0mm K-wires for provisional fixation

Instruments

Pelvic reduction set (Farabeuf clamps, Jungbluth clamps, ball spike pushers)
Cobb elevators (essential for subperiosteal dissection)
Small Hohmann retractors
Self-retaining retractors (Charnley, Balfour)
Reduction forceps (pointed, serrated)
Plate bending press and irons
Long drill bits and depth gauge

Adjuncts

Cell saver (blood loss 500-1500mL expected)
C-arm fluoroscopy (must achieve AP, obturator oblique, iliac oblique)
Radiolucent table
Vessel loops (for nerve/vessel protection)
Bone wax, Surgicel, topical haemostatics
Large-bore suction drains (19Fr)

Anaesthesia and Positioning

Anaesthesia

Preferred: General anaesthesia with arterial line
Considerations:
- Hypotensive anaesthesia (MAP 60-65) reduces blood loss
- TXA 1g IV at induction, repeat 1g at 3 hours
- Cell saver if anticipated blood loss >1L
- Avoid spinal/epidural (need to assess lower limb neurology post-op)

Patient Positioning

Positioning Checklist

Supine on radiolucent table
Small bump (folded towel) under ipsilateral buttock - internally rotates hemipelvis
Both arms tucked or one arm board (ensure brachial plexus protected)
Foley catheter (decompresses bladder, protects in medial window)
All pressure points padded
C-arm positioned on contralateral side for swing access
Ensure AP, obturator oblique (45° affected side down), iliac oblique (45° affected side up) achievable

Skin Preparation

2% chlorhexidine in alcohol
Prep: umbilicus to mid-thigh, midline to posterior axillary line
Include genitalia in prep (if extension to medial window needed)

WHO Checklist / Time Out

Correct patient, correct side (mark with permanent marker)
Consent confirmed with specific risks
Antibiotics given (cefazolin 2g IV within 60 min of incision)
VTE prophylaxis plan documented
Blood available (type and screen, 2-4 units)
Equipment checked (reduction instruments, plates, fluoroscopy)
Team briefing: anticipated blood loss, potential complications

Surface Anatomy and Landmarks

Surface Anatomy

Key Landmarks

ASIS (Anterior Superior Iliac Spine): Start point of incision, LFCN exits 10-20mm medial
Pubic Symphysis: End point of incision, medial window limit
Inguinal Ligament: Runs from ASIS to pubic tubercle - stay 2cm superior
Pubic Tubercle: Palpable 2cm lateral to symphysis, spermatic cord passes superficial
Iliac Crest: Lateral window extends along inner table

Incision

Type: Oblique curvilinear (bikini line modification)
Start: ASIS
Course: Curves medially along Langer's lines, 2cm above inguinal ligament
End: Pubic symphysis (can extend 2-3cm across midline if needed)
Length: 12-15cm (adjust for body habitus and fracture extent)

Mnemonic

LMM - Lateral, Middle, MedialThree Windows of Ilioinguinal

Surgical Approach

Surgical Approach - Ilioinguinal

Internervous Plane

Lateral Window: No true internervous plane - iliacus elevated subperiosteally
Middle Window: Between iliopsoas (femoral nerve) and external iliac vessels
Medial Window: Subperiosteal on superior pubic ramus

Superficial Dissection

Step 1: Skin and Subcutaneous

Incise skin along marked bikini line
Divide subcutaneous tissue and Scarpa's fascia
Identify and protect superficial epigastric vessels (ligate if crossing)
Expose external oblique aponeurosis

Step 2: External Oblique and LFCN

Incise external oblique aponeurosis 2cm above inguinal ligament
CRITICAL: Identify lateral femoral cutaneous nerve (LFCN) - exits 10-20mm medial to ASIS, crosses iliacus
Protect LFCN with vessel loop - most commonly injured nerve (70%)
If LFCN in way, may need to sacrifice (counsel patient: anterolateral thigh numbness)

LFCN Protection

The LFCN is the most commonly injured structure (70% temporary neuropraxia). Look for it early under the external oblique fascia, 1-2cm medial to ASIS, running obliquely over iliacus. Protect with vessel loop or sacrifice with informed consent.

Deep Dissection - Three Windows

LATERAL WINDOW (Iliac Wing)

Subperiosteal elevation of iliacus from inner table using Cobb elevator
Expose from ASIS posteriorly toward SI joint as needed
Pack with laparotomy sponge to maintain exposure
This gives access to iliac wing and superior anterior column

MIDDLE WINDOW (Pelvic Brim)

Identify iliopsoas muscle (lateral) and external iliac vessels (medial)
Create interval between these structures
Ligate lateral femoral circumflex vessels crossing this window
CRITICAL: Identify and ligate CORONA MORTIS if present (30% incidence)
- Aberrant obturator vessel connecting external iliac to obturator system
- Crosses 15-25mm from pubic symphysis
- Ligate prophylactically with clips or ties
Subperiosteal elevation along pelvic brim to quadrilateral plate
External iliac vessels: NEVER retract laterally (causes kinking) - only gentle medial retraction

Exam Pearl

Corona Mortis: Present in ~30% of patients. An aberrant connection between external iliac/inferior epigastric and obturator vessels. If avulsed during subperiosteal dissection, causes significant bleeding that is difficult to control. Always actively look for it 2-3cm from symphysis and ligate before avulsion.

MEDIAL WINDOW (Superior Pubic Ramus)

Detach rectus abdominis from pubic symphysis (tag for repair)
Identify spermatic cord (male) or round ligament (female)
Retract cord/ligament medially with Penrose drain
Subperiosteal elevation along superior pubic ramus
Stay on bone to protect bladder (10-20mm medial)
Expose Cooper's ligament (pectineal line) to pubic tubercle
Access to anterior column inferior extension and quadrilateral plate

Operative Technique

Step 1: Fracture Assessment

Debride fracture haematoma from all three windows
Assess fracture pattern under direct vision
Confirm CT findings - marginal impaction, loose bodies
Obtain fluoroscopy: AP, obturator oblique, iliac oblique
Plan reduction sequence based on fracture pattern

Key Principle: Restore pelvic brim continuity FIRST (middle window) as reference for remaining reduction

Exam Pearl

Examiner Question: "What fluoroscopy views do you obtain for acetabular fracture ORIF and what does each show?"

Model Answer: "I obtain three views: (1) AP pelvis - shows both columns, teardrop integrity, overall alignment; (2) Obturator oblique (45° affected side DOWN) - shows anterior column profile and posterior wall en face - best view for posterior wall reduction; (3) Iliac oblique (45° affected side UP) - shows posterior column profile and anterior wall en face. Each view shows one column in profile and the opposite wall en face. I must achieve all three to assess complete reduction."

Assessment Pitfalls

Not obtaining all 3 views - miss malreduction in one column
Missing marginal impaction - often not visible, correlate with CT
Ignoring loose bodies - must remove from joint to prevent chondrolysis
Rushing to reduce - proper assessment saves time and prevents re-do

Step 2: Fracture Reduction

Use Farabeuf or Jungbluth clamps
Ball spike pusher through stab incision for percutaneous joysticks
Pointed reduction forceps for fragment manipulation
Sequence: brim first, then superior (lateral window), then inferior (medial window)

Exam Pearl

Examiner Question: "What is your reduction sequence for anterior column fractures?"

Model Answer: "I follow the principle of restoring the pelvic brim first as the reference for remaining reduction. Sequence: (1) Debride haematoma from all windows; (2) Identify fracture pattern and key fragments; (3) Reduce pelvic brim in middle window using Farabeuf clamps - this is the 'keystone'; (4) Reduce superior fragments through lateral window; (5) Reduce inferior fragments through medial window. I verify with fluoroscopy (AP, obturator oblique, iliac oblique) before definitive fixation."

Large Fragment Reduction Dangers

Aggressive clamp placement - can fracture osteoporotic bone
Overtightening Farabeuf - causes fragment comminution
Not verifying with fluoro - may accept hidden malreduction
Wrong sequence - reducing ends before brim loses reference

Reduction Verification:

Direct vision: palpate articular surface through windows
Fluoroscopy: AP (both columns), obturator oblique (anterior column/posterior wall), iliac oblique (posterior column/anterior wall)
Goal: <2mm articular step-off

Reduction Goals

Anatomic reduction (<2mm articular displacement) is critical for outcome. Matta's data: Anatomic reduction = 85-90% good/excellent outcome. Non-anatomic = 50% poor outcome. Do not accept malreduction.

Step 3: Provisional Fixation

Use 2.0mm K-wires perpendicular to fracture line
Alternative: 2.7mm Schanz pins for larger fragments
Leave tails long for easy removal
Confirm no joint penetration with fluoroscopy (all 3 views)
Check stability of reduction before plating

Exam Pearl

Examiner Question: "How do you confirm your K-wires are not intra-articular?"

Model Answer: "I confirm with all three fluoroscopy views (AP, obturator oblique, iliac oblique). The key is that a K-wire may appear extra-articular on one view but penetrate joint on another. I look for: (1) Wire tip relationship to the teardrop on AP; (2) Wire relationship to the posterior wall on obturator oblique; (3) Wire relationship to the anterior wall on iliac oblique. If any doubt, I remove and reposition. An intra-articular wire causes chondrolysis and rapid arthritis."

Provisional Fixation Dangers

Intra-articular K-wire - causes chondrolysis, check ALL 3 views
Wire migration - use smooth wires, leave tails long for removal
Over-drilling - can breach joint, use depth stop if available
Wire through comminution - won't hold, use larger fragment

Step 4: Definitive Plate Fixation

Anterior Column Plate (Pelvic Brim):

Contour 3.5mm reconstruction plate to pelvic brim (inner table)
Plate runs from iliac wing, across brim, to superior pubic ramus
Position: on bone, medial to iliopectineal eminence
Screw placement:
- Iliac wing: bicortical 4.5mm or 3.5mm (30-50mm)
- Pelvic brim: unicortical 3.5mm directed posteriorly (20-35mm)
- Superior ramus: unicortical 3.5mm directed posteriorly
CRITICAL: Medially-directed screws risk external iliac vessels - direct posteriorly
Lag screws through plate for large non-comminuted fragments
Minimum 6 cortices each side of fracture

Exam Pearl

Safe Screw Trajectory: Screws along pelvic brim should be directed POSTERIORLY toward posterior column, NOT medially. Medially-directed screws risk external iliac vessels (10-20mm medial) and obturator vessels. Posterior direction is safe for 30-50mm screws.

Plate Fixation Dangers

Medially-directed screws - risk external iliac vessels, ALWAYS direct posteriorly
Insufficient cortices - need minimum 6 cortices each side of fracture
Over-contouring plate - weakens plate, may break
Intra-articular screw - check all 3 fluoro views before final tightening

Step 5: Quadrilateral Plate Support (If Needed)

Indication: Medial wall comminution or displacement, elderly with osteoporosis
Contour 3.5mm plate from superior ramus along quadrilateral plate
Position INFRAPECTINEAL (below pectineal line)
Screws directed posteriorly 30-40° into posterior column
Acts as buttress preventing femoral head medialization

Exam Pearl

Examiner Question: "When do you add a quadrilateral plate and how do you position it?"

Model Answer: "I add quadrilateral plate buttress for: (1) Medial wall comminution; (2) Elderly osteoporotic bone; (3) Central head protrusion. Positioning: Place the plate INFRAPECTINEAL (below the pectineal line) along the quadrilateral surface. Screws are directed posteriorly 30-40° into the posterior column - this avoids the hip joint. The plate acts as a buttress preventing the femoral head from medializing. Pre-contoured quadrilateral plates are now available and simplify this step."

Quadrilateral Plate Hazards

Suprapectineal placement - screws risk joint penetration
Medially-directed screws - risk obturator vessels and bladder
Inadequate buttress - head will medialize with weight-bearing
Not recognizing need - comminuted medial wall WILL fail without buttress

Step 6: Final Fluoroscopy

Remove all provisional K-wires
Obtain definitive AP, obturator oblique, iliac oblique views
Verify:
- Anatomic reduction all columns
- No intra-articular screws (critical - causes chondrolysis)
- Adequate screw purchase
- Joint congruency restored
Document images in operative record

Exam Pearl

Examiner Question: "What are you looking for on your final fluoroscopy images?"

Model Answer: "On final fluoroscopy, I systematically verify: (1) Reduction quality - <2mm step-off in weight-bearing dome on all views; (2) No intra-articular hardware - check each screw on all 3 views, a screw may look extra-articular on one view but penetrate joint on another; (3) Screw purchase - bicortical where possible, not protruding posteriorly; (4) Joint congruency - concentric femoral head, no subluxation; (5) Overall alignment - pelvic brim restored, no gapping. I save images for the operative record."

Final Check Errors

Only checking one view - intra-articular screw may be hidden on single view
Accepting step-off - >2mm predicts poor outcome, revise now not later
Not documenting images - medicolegal protection, save all views
Missing loose bodies - cause chondrolysis, must remove before closure

Closure

Wound Closure

Haemostasis

Systematic check of all three windows
Bone wax for iliac wing bleeding points
Cautery for soft tissue bleeders
Topical haemostatics (Surgicel, Floseal) for ooze
Irrigation with 3L normal saline minimum

Drain Placement

Large-bore drain (19Fr) in lateral and/or middle window
Route away from vessels and nerves
Secure to skin, connect to suction
Remove when output <30mL/8hrs (typically 48-72 hours)

Layered Closure

Deep: Repair rectus abdominis to pubic periosteum (0 Vicryl)
Middle: Approximate external oblique over inguinal ligament (0 Vicryl)
Scarpa's fascia: 2-0 Vicryl (reduces dead space, hernia risk)
Dermis: 3-0 Vicryl or Monocryl
Skin: Subcuticular 4-0 Monocryl or staples

Dressing

Waterproof adhesive dressing
Abdominal binder for comfort
Mark drain exit sites

Intra-operative Complications

External Iliac Vessel Injury

Recognition: Sudden profuse bleeding, hypotension
Prevention: Stay on bone, retract vessels gently medially, identify corona mortis
Management:
1. Direct pressure immediately
2. Call vascular surgery
3. Proximal and distal control
4. Primary repair or interposition graft
5. Fasciotomies if prolonged ischaemia

Corona Mortis Bleeding

Recognition: Sudden arterial bleeding from medial window
Prevention: Actively identify and ligate BEFORE avulsion
Management: Direct pressure, clip or suture ligation

Exam Pearl

Examiner Question: "You encounter sudden profuse bleeding from the middle window. What do you do?"

Model Answer: "I immediately apply direct pressure with a laparotomy pack and call for help. I suspect external iliac vessel injury. Steps: (1) Maintain pressure while team activates massive transfusion protocol; (2) Call vascular surgery immediately; (3) Extend incision if needed for proximal control; (4) Once vascular surgeon arrives, obtain proximal and distal control with vessel loops or clamps; (5) Identify injury - primary repair if clean laceration, interposition graft if complex; (6) Check distal pulses post-repair; (7) Fasciotomies if ischaemia time >4-6 hours."

Vascular Emergency Protocol

NEVER retract vessels laterally - causes kinking and injury
Pack and hold - don't blindly clamp, will worsen injury
Call early - vascular surgery takes time to arrive
Know proximal control - common iliac above inguinal ligament

Post-operative Care

Post-operative Management

Immediate (Recovery - Day 0)

Neurovascular check documented (femoral and sciatic nerve function)
Post-operative X-rays (AP pelvis, Judet views)
VTE prophylaxis: LMWH (enoxaparin 40mg SC) starting 12 hours post-op
Pain management: PCA, then oral analgesia
Drain output monitoring

Day 1-3

Mobilise with physiotherapy: toe-touch weight bearing
Continue VTE prophylaxis
HO Prophylaxis (start Day 1):
- Indomethacin 75mg PO daily × 6 weeks (preferred), OR
- Single-dose radiation 700 cGy within 72 hours (if NSAID contraindicated)
Remove drains when output <30mL/8hrs (typically 48-72h)
Wound check before discharge

Discharge Criteria

Pain controlled on oral analgesia
Mobilising safely with frame/crutches
Wound clean and dry
Understands weight-bearing restrictions
VTE prophylaxis plan (LMWH or DOAC × 4-6 weeks)
HO prophylaxis plan
Follow-up arranged

Weight-bearing Protocol

Fracture Pattern	Weight-bearing	Duration
Simple anterior column	Toe-touch	6-8 weeks
Anterior + PHT	Toe-touch	8-10 weeks
Both column	Toe-touch	10-12 weeks
With comminution	Toe-touch	12 weeks

Follow-up Schedule

2 weeks: Wound check, suture/staple removal
6 weeks: Clinical review, X-rays, consider advancing weight-bearing
12 weeks: Clinical review, X-rays, usually progress to full weight-bearing
6 months: X-rays, assess for AVN, HO, arthritis
1 year: X-rays, functional outcome assessment
Ongoing: Annual or as symptoms dictate

Watch for Complications

AVN: MRI at 6-12 months if groin pain (10-20% incidence)
Post-traumatic arthritis: Progressive joint space narrowing (20-30%)
HO: Brooker classification on X-rays
Hardware symptoms: May require removal after union (12-18 months)

Viva Scenarios

Exam Viva Scenarios

Practice these scenarios to excel in your viva examination

VIVA SCENARIOStandard

EXAMINER

"A 35-year-old motorcyclist presents after a high-speed collision with displaced anterior column acetabular fracture. CT shows 8mm displacement at the pelvic brim with quadrilateral plate involvement. How would you manage this patient?"

EXCEPTIONAL ANSWER

I would manage this with operative fixation via an ilioinguinal approach. The indications for surgery are clear: pelvic brim displacement >5mm and quadrilateral plate involvement. My pre-operative planning would include full trauma workup, CT with 3D reconstruction to classify the fracture (Judet-Letournel), assessment of associated injuries, and optimization for surgery at 3-7 days when swelling permits. I would perform the ilioinguinal approach with three windows: lateral for iliac wing exposure, middle for pelvic brim between iliopsoas and external iliac vessels, and medial for pubic ramus. Key dangers include LFCN (identify early, protect with vessel loop), external iliac vessels (retract medially only), and corona mortis (ligate prophylactically in 30%). I would reduce the fracture anatomically (<2mm step-off), fix with 3.5mm reconstruction plate along the pelvic brim, and add quadrilateral plate buttress if needed. Post-operatively: toe-touch weight-bearing 8-10 weeks, indomethacin for HO prophylaxis, LMWH for VTE prophylaxis.

VIVA SCENARIOStandard

EXAMINER

"Describe the corona mortis. Why is it clinically significant and how do you manage it?"

EXCEPTIONAL ANSWER

The corona mortis, meaning 'crown of death', is an aberrant vascular connection between the external iliac or inferior epigastric vessels and the obturator system. It is present in approximately 30% of patients (10-30% depending on study), crossing the superior pubic ramus 15-25mm lateral to the pubic symphysis. It is clinically significant because during anterior acetabular surgery, subperiosteal dissection in the medial window can avulse this vessel, causing sudden arterial bleeding that retracts into the pelvis and is very difficult to control. The management is PROPHYLACTIC identification and ligation. I actively look for it in every case during medial window dissection, 2-3cm from the symphysis. When identified, I ligate it with clips or ties BEFORE it can be avulsed. If inadvertently avulsed, I apply direct pressure immediately, improve exposure, and achieve control with clips, suture ligation, or packing.

VIVA SCENARIOStandard

EXAMINER

"How do you assess acetabular fracture reduction quality, and what is the evidence for anatomic reduction?"

EXCEPTIONAL ANSWER

Reduction quality is assessed both intraoperatively and postoperatively. Intraoperatively, I use direct palpation of the articular surface through the surgical windows and fluoroscopy with AP, obturator oblique (shows anterior column and posterior wall), and iliac oblique (shows posterior column and anterior wall) views. I aim for less than 2mm articular step-off. Postoperatively, I obtain CT scan if there is any doubt about articular reduction. The evidence for anatomic reduction comes from Matta's landmark studies showing that anatomic reduction (<2mm displacement) results in 85-90% good-to-excellent clinical outcomes, while non-anatomic reduction results in only 50% good outcomes. Letournel's data showed similar findings with anatomic reduction yielding 80% good results versus 50% with imperfect reduction. Even with anatomic reduction, 20-30% of patients develop post-traumatic arthritis requiring THA at 10-15 years, highlighting the severity of these injuries.

Key Exam Points

What Examiners Want to Hear

Critical Yield Data

10Judet-Letournel patterns (draw all)

3Windows of ilioinguinal

30%Corona mortis incidence

<2mmReduction goal

Must-Know Facts for Viva

Classification: Draw all 10 Judet-Letournel patterns - 5 elementary (anterior wall, anterior column, posterior wall, posterior column, transverse) + 5 associated (T-type, posterior column + wall, transverse + posterior wall, anterior column + PHT, both column)
Surgical Indications: Roof arc <45°, dome impaction, posterior wall >40%, displaced through weight-bearing dome >2mm, brim >5mm
Three Windows:
- Lateral: ASIS to SI joint, LFCN at risk
- Middle: Between iliopsoas and external iliac vessels, corona mortis
- Medial: Superior pubic ramus, bladder at risk
Danger Structures with Distances:
- LFCN: 10-20mm medial to ASIS (70% injury rate)
- External iliac: 10-20mm medial to pelvic brim
- Corona mortis: 15-25mm from symphysis (30% present)
- Bladder: 10-20mm medial to superior ramus
Outcomes Data:
- Matta: anatomic reduction = 85-90% good outcome
- Non-anatomic = 50% good outcome
- 20-30% THA conversion at 10-15 years despite good reduction

Anterior Column Acetabular Fracture ORIF - Quick Reference

High-Yield Exam Summary

References

Key References

Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632-45.
Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed. Springer-Verlag; 1993.
Giannoudis PV, et al. Operative treatment of displaced fractures of the acetabulum: a meta-analysis. J Bone Joint Surg Br. 2005;87(1):2-9.
Tile M, et al. Fractures of the Pelvis and Acetabulum: Principles and Methods of Management. 4th ed. Thieme; 2015.
Tornetta P 3rd, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res. 1996;(329):186-93.
Karunakar MA, et al. Iatrogenic nerve palsy after acetabular surgery. J Orthop Trauma. 2003;17(2 Suppl):S19-25. [LFCN injury data]
Okcu G, Erkan S. The corona mortis: a systematic review. Surg Radiol Anat. 2004;26(6):475-81.

Acetabular Fracture ORIF - Anterior Column