S Ruchholtz1, G Taeger, R Zettl. 1. Klinik für Unfall-, Hand-, und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße 10, 35043 Marburg. ruchholt@med.uni-marburg.de
Abstract
OBJECTIVES: To present a novel two-incision minimally invasive (TIMI) method for the treatment of anterior acetabular fractures. INTERVENTION: The first TIMI incision is performed using a pararectal approach at the level of the proximal third of the arcuate line of the ilium. After transection of the abdominal wall the iliac vessels are mobilized medially and the neuromuscular bundle laterally. The second approach lies above the medial pubic bone. The soft tissue is held back using a retraction system. After fracture reduction and fixation by isolated screws a conventional reconstruction plate is inserted for fracture neutralization. RESULTS: Since January 2008 we have performed the TIMI method in 88 cases with good results. Recently we have published the data of a first series with 26 patients that were seen at least 12 months after surgery. The mean operative time was 109 ± 30 min and all incisions showed primary healing. Postoperative radiological examination revealed an anatomic reduction in 20 fractures and a satisfactory reduction in 6. There were no local soft tissue complications and no revisions were needed. Follow-up examinations were performed after a minimum of 12 months in 19 patients (73%). The average Harris hip score (HHS) was 86.6 ± 8. Quality of life was comparable to control persons in the same age group. CONCLUSIONS: The TIMI approach represents a viable alternative to the ilioinguinal approach. Despite the limited number of incisions a comparable quality of fracture reduction is achieved. The authors believe this technique would be most useful in patients with a higher risk for postoperative soft tissue complications.
OBJECTIVES: To present a novel two-incision minimally invasive (TIMI) method for the treatment of anterior acetabular fractures. INTERVENTION: The first TIMI incision is performed using a pararectal approach at the level of the proximal third of the arcuate line of the ilium. After transection of the abdominal wall the iliac vessels are mobilized medially and the neuromuscular bundle laterally. The second approach lies above the medial pubic bone. The soft tissue is held back using a retraction system. After fracture reduction and fixation by isolated screws a conventional reconstruction plate is inserted for fracture neutralization. RESULTS: Since January 2008 we have performed the TIMI method in 88 cases with good results. Recently we have published the data of a first series with 26 patients that were seen at least 12 months after surgery. The mean operative time was 109 ± 30 min and all incisions showed primary healing. Postoperative radiological examination revealed an anatomic reduction in 20 fractures and a satisfactory reduction in 6. There were no local soft tissue complications and no revisions were needed. Follow-up examinations were performed after a minimum of 12 months in 19 patients (73%). The average Harris hip score (HHS) was 86.6 ± 8. Quality of life was comparable to control persons in the same age group. CONCLUSIONS: The TIMI approach represents a viable alternative to the ilioinguinal approach. Despite the limited number of incisions a comparable quality of fracture reduction is achieved. The authors believe this technique would be most useful in patients with a higher risk for postoperative soft tissue complications.
Authors: Björn Gunnar Ochs; Ivan Marintschev; Heike Hoyer; Bernd Rolauffs; Ulf Culemann; Tim Pohlemann; Fabian Maria Stuby Journal: Injury Date: 2010-05-06 Impact factor: 2.586
Authors: Steffen Ruchholtz; Benjamin Buecking; Anne Delschen; Ulrike Lewan; Georg Taeger; Christian Kuehne; Ralph Zettl Journal: J Orthop Trauma Date: 2013-05 Impact factor: 2.512
Authors: Romney C Andersen; Robert V O'Toole; Jason W Nascone; Marcus F Sciadini; H Michael Frisch; Clifford W Turen Journal: J Orthop Trauma Date: 2010-05 Impact factor: 2.512