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The Pararectus Approach: A New Concept.

Marius J B Keel1,2, Klaus-Arno Siebenrock1, Moritz Tannast1

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The Pararectus approach offers a less invasive surgical option for acetabular fractures, providing excellent exposure and favorable outcomes compared to traditional methods. This technique enhances visualization and access to the hip joint without extensive dissection.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Surgical Anatomy

Background:

  • The ilioinguinal approach is the gold standard for acetabular fractures, but changing fracture patterns necessitate alternative techniques.
  • The modified Stoppa approach offers a less invasive intrapelvic option.
  • The Pararectus approach provides direct intrapelvic access with enhanced visualization.

Purpose of the Study:

  • To describe the Pararectus approach for acetabular fracture fixation.
  • To compare the Pararectus approach with the ilioinguinal and Stoppa approaches.
  • To highlight the benefits of the Pararectus approach in terms of exposure and outcomes.

Main Methods:

  • A skin incision along the lateral border of the rectus abdominis muscle.
  • Dissection through the retroperitoneal space to expose pelvic structures.
  • Identification and management of relevant vessels and nerves (e.g., corona mortis, obturator nerve).
  • Subperiosteal exposure of the pubic ramus, quadrilateral plate, and posterior column.
  • Use of fluoroscopy and optional arthroscopy for reduction and fixation.

Main Results:

  • The Pararectus approach provides direct surgical access above the hip joint.
  • It offers intrapelvic visualization comparable to the Stoppa approach.
  • Demonstrates safe surgical dissection with enhanced exposure and favorable outcomes.

Conclusions:

  • The Pararectus approach is a valuable alternative for acetabular fracture treatment.
  • It combines advantages of both ilioinguinal and Stoppa approaches.
  • Offers improved surgical access and outcomes without inguinal canal dissection.