Compression Osteosynthesis Without Iliac Crest Osteotomy Through the Anterior Iliac Approach for Incomplete High...

Introduction: An incomplete high anterior column fracture of the acetabulum is commonly considered to require completion of the fracture. However, reduction may become more difficult after completing the incomplete fracture due to plastic deformation. This study describes a surgical technique of compression osteosynthesis without completing the incomplete fracture and evaluates the clinical and radiographic outcomes. Materials and Methods: In this retrospective study, 25 patients with incomplete high anterior column fractures met the inclusion criteria. The fracture was reduced and stabilized by compression osteosynthesis through the anterior iliac approach without completing the incomplete fracture in the iliac wing. Patient demographics, the mechanism of injury, associated injuries, time to surgical reconstruction, operation time, and postoperative complications were analyzed. The quality of reduction and outcome were evaluated according to Matta's criteria. Results: The mean operation time was 110 ± 23 min (range, 75-160). All fractures achieved bone union at a mean of 10.2 ± 1.4 weeks (range, 8-14). The quality of fracture reduction was graded as anatomical in 22 hips, imperfect in one and poor in two. Clinical results were excellent in 19 patients and good in six, and radiographic results were excellent in 22 patients and good in three. No statistically significant differences were observed between patients with and without quadrilateral plate fractures. Lateral femoral cutaneous nerve injury occurred in 13 patients (52%), mostly without significant symptoms. One patient experienced vascular injury. Conclusions: Incomplete high anterior column fractures can be effectively reduced and stabilized by compression osteosynthesis through the anterior iliac approach without completing the incomplete fracture in the iliac wing. This case series demonstrated favorable clinical and radiographic outcomes using this surgical technique. However, because this study was a retrospective case series with a small sample size and no comparative control group, further studies are required to confirm these findings.