Approach - related results after acetabular fractures

Acetabular fractures are severe injuries. Making a diagnosis and deciding on therapy are difficult because of the complexity of the anatomic structure and because of the soft tissues. Choosing the most suitable approach is the most important problem when deciding on the operative treatment. Besides standard approaches (Kocher/Langenbeck, ilioinguinal and extended iliofemoral), the "Maryland approach" has been established in the last few years. Modifying the steps of preparation, it is possible to begin the operation with a Kocher/Langenbeck approach (with variation on where the skin incision is made) and to extend the approach step by step to achieve optimal exposure. Here we describe the results of acetabular fractures treated between 1989 and 1994 (n = 159) in our clinic related to the surgical approach. The "modified Maryland approach" as used in our clinic, starts with exposure of the dorsal column, offering the possibility of a universal exposure.