THE LETOURNEL EXTENSIVE ILIOFEMORAL APPRO ACH IN COMPLEX ACETABULAR FRACTURES - A PROSPECTIVE-STUDY

1. Purpose of the study The authors present the anatomical and functio nal results of the systematic use of Letournel's extensive lateral app roach for internal fixation of the fractures of the acetabulum involvi ng the two columns. 2. Material This prospective study concerns 25 pat ients. Mean age was 38 years. Mean follow-up was 4 years and 6 months (with extremes of 1 year and 9 years 9 months). 13 cases had a minimum of 4 years of follow-up. There were 1 transversal fracture, 9 transve rsal fractures associated with a posterior wall fracture, 2 anterior c olumn fractures associated with a hemitransversal posterior fracture, 6 ''T'' shaped fractures, 7 fractures of the two columns. During the p rocedure, a trochanterotomy was carried out. Not any of the patients w as irradiated postoperatively and they did not take any indomethacin. The patients were operated on 10 days after the accident, on average ( with the extremes of 2 and 60 days). The average time of the procedure was 4 H 20 and 1080 cc of globular sediment were used during the inte rvention on average. The same surgeons participated in each operation. 3. Methods The anatomical results were analysed according to Matta's criteria and the congruence study head-roof and head-acetabulum of the SOFCOT symposium in 1981. The functional results were analysed using the quotation of Merle d'Aubigne. Complications were searched systemat ically. The appearance of heterotopic ossifications was analysed accor ding to Brooker. 4. Results 23 patients had a satisfactory anatomical reduction and 11 patients out of 13 did not present any arthrosis afte r a minimum of 4 years follow-up. 12 patients had very good or good fu nctional results. 3 patients had no heterotopic ossifications, 7 were grade I, 5 grade II, 8 grade III, and 2 grade IV. The gluteus medius w as quoted 4 in 18 patients and 5 in 5 patients. There were 2 cases of deep suppuration, one of them was a patient who died 6 months later of a pancreas cancer unrecognized at the time of the accident. There wer e 5 aseptic osteonecroses and 3 cases of regressive paralysis of the s ciatic nerve. 4 total hip prosthesis were inserted secondarily. 5. Dis cussion The Letournel extensive lateral approach was efficient to obta in an anatomical reduction but, functionnally, it was only efficient i n one case out of two. For the moment, the authors associate systemati cally a postoperative irradiation to reduce the ossifications (10 to 1 2 gray in 5 sessions). On the other hand, they try to obtain a more ef ficient reinsertion of the glutei muscles, thank to a bone fragment of the iliac crest. 6. Conclusion The authors limit their indications of the Letournel's extensive lateral approach to the fractures of the tw o columns, not older than 10 days or to the comminuted ones.