The monoportal endoscopic intrapelvic approach for acetabular fracture fixation: a technical note

Minimally invasive strategies are increasingly being developed for acetabular fractures. Although the AIP approach provides reliable access to the pelvic brim, quadrilateral surface, and medial posterior column, it still requires conventional open exposure and sustained soft-tissue retraction. We describe a fully extraperitoneal monoportal endoscopic technique based on the fundamental steps of the AIP approach but performed through a single suprapubic mini-incision without fixed soft-tissue traction. By simultaneously accessing the preperitoneal and retroperitoneal spaces, this method allows controlled identification of intrapelvic structures at risk and enables fracture reduction and buttress plate fixation under combined endoscopic and fluoroscopic guidance. In carefully selected fracture patterns, this technique represents a minimally invasive adaptation of the AIP exposure rather than a novel surgical approach, offering unique exposure perspectives that are not achievable through conventional approaches. Level of Evidence: IV; technical note.