Clinical application of modified lateral-perineal approach for obturator ring injuries

Anterior pelvic ring injuries frequently involve obturator ring disruption. With advancements in surgical techniques and rising patient expectations, there is growing interest in repairing these injuries within anterior pelvic ring treatment strategies. While current approaches (e.g., transabdominal, ilioinguinal) are used, they present limitations. This study describes a Modified Lateral-Perineal Approach (MLPA) for treating obturator ring fractures.

We retrospectively reviewed 22 pelvic fracture patients with obturator ring injuries that had been treated via the MLPA. All patients underwent open reduction and internal fixation (ORIF) between June 2019-June 2024. According to the Tile classification, there were 16 type B fractures and 6 case of type C fractures. All patients had a reduction and fixation to the fracture of the superior pubic ramus and inferior ramus of pubis-ischium ramus. Incision length, operative time, blood loss, time to sitting/weight-bearing, union time, adductor strength (MRC 0-5), satisfaction and complications were recorded. The quality of fracture reduction was evaluated according to Matta radiographic criteria. The pelvic function was evaluated according to Majeed Pelvic Score at the last follow-up.

Twenty-two patients (10 male, 12 female; mean age 49.7 ± 13.7 years) were included. Mean follow-up was 15 ± 3 months. Mean surgical parameters: incision length 8.5 ± 1.1 cm, operative time 106.4 ± 23.4 min, blood loss 89.1 ± 41.2 mL. All achieved "excellent" Matta scores. Functional recovery: sitting at 6.6 ± 3.4 days, partial weight-bearing at 15.7 ± 7.2 days, full weight-bearing at 8.9 ± 2.5 weeks. Radiographic union occurred at 9.5 ± 2.4 months. One-year Majeed score averaged 88.5 ± 4.5. Adductor strength was MRC grade IV in 3 patients and V in 19. All patients expressed satisfaction. There were no complications of nonunion, internal fixation failure, vascular injury, nerve palsy, or hernia. All of the patients were esthetically satisfied with the scar.

The MLPA provides a safe and effective simultaneous exposure of the obturator ring's key structures: the superior pubic ramus, inferior ramus of pubis-ischium ramus. The advantage of this approache to repair the obturator ring include safety, simplicity, early weight-bearing, aesthetics, and satisfactory clinical efficacy with a low incidence of complications.