The modified Gibson approach to the acetabulum.

OBJECTIVE: Providing a surgical approach similar to the Kocher-Langenbeck but having improved anterosuperior access, less risk of injury to branches of the inferior gluteal nerve supplying the anterior portion of the gluteus maximus muscle, and improved cosmesis. INDICATIONS: Any surgery that would otherwise call for the Kocher-Langenbeck approach. CONTRAINDICATIONS: Fractures of the anterior column and/or wall; transtectal T-shaped fractures. Transverse fractures and infra/juxtatectal T-shaped fractures having the major displacement anteriorly at the pelvic brim with only minor posterior displacement. SURGICAL TECHNIQUE: Exposure of the acetabulum fracture through a straight skin incision, developing the plane between the anterior border of the gluteus maximus muscle and the tensor fasciae latae. The gluteus maximus is reflected posteriorly to reveal the underlying deep anatomic structures. POSTOPERATIVE MANAGEMENT: Thromboprophylaxis and prophylaxis as indicated for the prevention of heterotopic ossification are instituted. The patient is mobilized as quickly as the associated injuries will allow. Toe-touch weight-bearing is continued for 10-12 weeks. However, progression to full weight-bearing should be individualized.
RESULTS: Between 1996 and 2000, 16 patients having a fracture of the acetabulum were operated on through the modified Gibson approach with 15 patients followed up for 1 year or more. Fracture types were posterior wall in eight patients, transverse in one, posterior column and wall in two, transverse and posterior wall in four, and T-shaped in one. There were no intraoperative or immediate postoperative complications. Clinical outcome was determined using a modification of the method developed by Merle d'Aubigné and Postel and was good-to-excellent in 14 patients and poor in one (a patient who developed osteonecrosis of the femoral head unrelated to the approach).