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Trauma: D. B. Griffin, P. E. Beaulé, and J. M. Matta Safety and efficacy of the extended iliofemoral approach in the treatment of complex fractures of the acetabulum J Bone Joint Surg Br 2005; 87-B: 1391-1396 [Abstract] [Full text] [PDF]

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Extended iliofemoral approach

H David Moehring   (20 April 2006)

Extended iliofemoral approach 20 April 2006
H David Moehring UC Davis Medical Center Send letter to journal: Re: Extended iliofemoral approach david.moehring{at}ucdmc.ucdavis.edu H David Moehring	Sir, Having heard the presentation of the data reported by Matta several years ago, I read Griffin et al's article with interest. The number of patients in the study is a reflection of the pioneering dedication of Dr Matta to this labour-intensive and challenging surgery. Nevertheless, the study would have been enhanced by noting the subsequent displacement at follow-up compared with initial X-rays, and also the location of the displacement in reference to the columns, quadrilateral plate, and posterior wall. Might there not be differences in clinical outcomes? Also, the stratification of radiographic displacement inexplicably leaves out a group for fractures displaced 1-2 mm. If these fractures were included in the (0-1 mm) group this would result in a spurious number of 'anatomic' reductions. Conversely, if included in the 2-3 mm group the number of 'imperfect' results would be larger. While the conclusion that outcomes are improved with better reduction seems intuitively obvious, it is not necessarily substantiated by the data as presented. The degree of femoral head damage which occurs to some extent in nearly all acetabular fractures was not quantified, rendering the conclusions of the study in this regard suspect. Finally, while the extended iliofemoral approach provides a commanding view, it does so at the expense of the soft tissue with a higher incidence of heterotopic bone and abductor weakness, as the authors have noted. Probably the most useful information in the article is that this approach should be avoided wherever possible for less brutalising access to the acetabulum. H.D. Moehring, MD UC Davis Medical Center, Sacramento, California, USA.