Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2634-2640
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2634
Modified pararectus approach for treatment of atypical acetabular anterior wall fracture: A case report
Jun-Jie Wang, Jiang-Dong Ni, De-Ye Song, Mu-Liang Ding, Jun Huang, Guang-Xu He, Wen-Zhao Li
Jun-Jie Wang, Jiang-Dong Ni, De-Ye Song, Mu-Liang Ding, Jun Huang, Guang-Xu He, Wen-Zhao Li, Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Author contributions: Wang JJ, Ni JD, Song DY, and He GX performed the surgery and wrote the paper; Wang JJ, Ding ML, and Huang J collected the information and followed the patient; Song DY and Li WZ revised the paper; all authors read and approved the final manuscript.
Supported by the Xiangya Famous Doctors of Central South University, No. 201468.
Informed consent statement: The patient provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: De-Ye Song, MD, Chief Doctor, Professor, Department of Orthopedics, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha 410011, Hunan Province, China. songdeye@csu.edu.cn
Received: March 7, 2020
Peer-review started: March 7, 2020
First decision: April 22, 2020
Revised: May 14, 2020
Accepted: May 26, 2020
Article in press: May 26, 2020
Published online: June 26, 2020
Abstract
BACKGROUND

Acetabular anterior wall fracture with preservation of the pelvic brim is extremely rare. It is different from anterior wall fracture classified by Judet and Letournel. Few studies have reported cases treated by open reduction and internal fixation via the Smith-Petersen or iliofemoral approach.

CASE SUMMARY

We report a 48-year-old Chinese woman who had difficulty moving her right hip from abduction and external rotation after falling from 3 m. Pelvic radiograph and three-dimensional reconstruction of computed tomography revealed acetabular anterior wall fractures combined with fractures of the anterior inferior iliac spine and the iliac wing but not involving the pelvic brim. First, the patient underwent interim management by closed reduction of the hip dislocation and skin traction for 6 d. Then, we used a modified pararectus approach for treatment to fix the acetabular fractures with a reconstruction plate and nonlocking T-shape plate. At the 9-mo follow-up, the patient could walk painlessly without necrosis of the femoral head or heterotopic ossification, and the X-rays and computed tomography scan reconstructions showed good bone union.

CONCLUSION

The modified pararectus approach described here can facilitate exposure, reduction, and osteosynthesis for atypical acetabular fracture with less invasiveness.

Keywords: Acetabulum, Fracture, Modified, Pararectus approach, Case report

Core tip: Acetabular anterior wall fracture without involvement of the pelvic brim is extremely rare. We present a case about the surgical outcome of a patient with atypical acetabular anterior wall fracture. The patient underwent open reduction and internal fixation via a modified pararectus approach that has not been reported. Follow-up X-ray and computed tomography scans showed satisfactory bone union. The function of the hip was excellent at the 9-mo follow-up after surgery.