Operative treatment of complex acetabular fractures through the modified extensile iliofemoral approach (Maryland)

Forty-nine patients with 50 complex acetabular fractures were treated with open reduction and internal fixation from August 1993 to February 1996 in a prospectively documented study. The fractures were fixed with small fragme nt implants through a modified extensile iliofemoral approach (Maryland app roach). Thirty-seven patients were polytraumatized with an ISS of 20 pts. o n average. In 10 patients the ISS was > 25 pts. Good or anatomic initial fr acture reduction with a fragment stepoff less than or equal to 2 mm could b e achieved in 48 fracturers (96 %). Thirty-six patients with 37 fractures c ould be evaluated after 25 months on average. In 28 fractures (76 %) the fu nctional outcome was good or excellent according to the d'Aubigne and Harri s scores. Radiological results were excellent in 21 fractures (57%) and sat isfactory in 12 fractures (Heeg score). In 7 cases (14 %) a postoperative s ubcutaneous seroma had to be treated surgically. No wound infections, howev er, were observed. Further complications were secondary a loss of reduction in 4 cases (11 %), relevant heterotopic ossifications (Brooker III/IV) in 5 cases (14 %), and aseptic femoral head necrosis in 2 cases (5 %). In two cases a total hip replacement (THR) for posttraumatic arthritis had to be p erformed. Two more cases are scheduled for THR due to symptomatic femoral h ead necrosis. A good joint reconstruction can be achieved through the modif ied extensile iliofemoral approach (Maryland) in complex fractures of the a cetabulum. However, the approach related morbidity seems to be worrysome. I n complex fractures with comminution in the roof of the acetabulum the prog nosis remains uncertain even in cases where initial anatomic joint reconstr uction can be achieved.