Dogan Atlihan1, Mahmud Aydin2, Sercan Capkin3, Serkan Surucu4, Fatih Gunaydin5, Halil Ibrahim Acar6. 1. Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, Istanbul, Turkey. datlihan@gmail.com. 2. Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, Istanbul, Turkey. 3. Department of Orthopedics and Traumatology, Aksaray University Education Research Hospital, Aksaray, Turkey. 4. Department of Orthopedics and Traumatology, University of Missouri Kansas City, Kansas City, USA. 5. Mersin City Training and Research Hospital, Mersin, Turkey. 6. Department of Anatomy, Faculty of Medicine, Ankara University, Ankara, Turkey.
Abstract
INTRODUCTION: The aim of our study was to visualize all the windows used in the pararectus approach with detailed cadaver images to facilitate better understanding of orthopedic surgeons and, in addition, was to modify the incision used in the pararectus approach to a more cosmetic bikini incision. MATERIALS AND METHODS: In total, 20 cadavers fixed in 10% formalin were used in this study. Of these cadavers, 14 were male and six were female, with a mean age at death of 57 (42-82 years). The four windows were defined as follows in all the cadavers: pubic, quadrilateral, sacroiliac, and iliac windows. RESULTS: The most important structure at risk in the pubic window was the corona mortis, as it was observed in 12 (60%) cadavers. In men, the spermatic cord was an important structure at risk in the pubic window. The obturator vessels and nerves were the structures at most risk in the quadrilateral window due to their close location with the quadrilateral surface. The obturator nerve on the medial side and at the entrance of the pelvis through the linea terminalis and lumbosacral truncus were the structures at most risk close to the sacroiliac joint in the sacroiliac window. CONCLUSION: This anatomical study includes highly instructive visual shapes and cadaver images for the acetabulum and pelvis, whose anatomical structures are quite complex. We have found that this modified pararectus approach provides excellent access to the internal pelvic rim. CLINICAL RELEVANCE: The anatomical data regarding the modified pararectus approach in this study will assist orthopedic surgeons in the surgical management of acetabular and pelvic fractures.
INTRODUCTION: The aim of our study was to visualize all the windows used in the pararectus approach with detailed cadaver images to facilitate better understanding of orthopedic surgeons and, in addition, was to modify the incision used in the pararectus approach to a more cosmetic bikini incision. MATERIALS AND METHODS: In total, 20 cadavers fixed in 10% formalin were used in this study. Of these cadavers, 14 were male and six were female, with a mean age at death of 57 (42-82 years). The four windows were defined as follows in all the cadavers: pubic, quadrilateral, sacroiliac, and iliac windows. RESULTS: The most important structure at risk in the pubic window was the corona mortis, as it was observed in 12 (60%) cadavers. In men, the spermatic cord was an important structure at risk in the pubic window. The obturator vessels and nerves were the structures at most risk in the quadrilateral window due to their close location with the quadrilateral surface. The obturator nerve on the medial side and at the entrance of the pelvis through the linea terminalis and lumbosacral truncus were the structures at most risk close to the sacroiliac joint in the sacroiliac window. CONCLUSION: This anatomical study includes highly instructive visual shapes and cadaver images for the acetabulum and pelvis, whose anatomical structures are quite complex. We have found that this modified pararectus approach provides excellent access to the internal pelvic rim. CLINICAL RELEVANCE: The anatomical data regarding the modified pararectus approach in this study will assist orthopedic surgeons in the surgical management of acetabular and pelvic fractures.
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