Osteotomy of the Anterior Superior Iliac Spine as an Adjunct to Improve Access and Visualization Through the Lateral Window.

The lateral "window" has previously been described as part of the ilioinguinal and anterior intrapelvic approaches for gaining access to the anterior aspect of the sacroiliac joint, the internal iliac fossa, and upper portion of the anterior column for reduction and placement of fixation. Surgical exposure of this window typically involves release of the external oblique muscle from the iliac crest and elevation of the iliacus muscle from the internal iliac fossa. This exposure is limited by the residual attachment of the external oblique muscle and inguinal ligament to the anterior superior iliac spine, particularly in patients with a large abdomen or in fractures that involve the anterior wall of the acetabulum and pubic root region. Herein, we describe the addition of an osteotomy of the anterior superior iliac spine for improved medial mobilization of the abdominal wall musculature to allow better visualization and access to the internal iliac fossa and anterior aspect of the sacroiliac joint.