Functional outcome of complex acetabular fractures by combined anterior and posterior approach in a single sitting: a case report


  • Neetin P. Mahajan Department of Orthopedics, J. J. Hospital, Mumbai, Maharashtra, India
  • Amey Sadar Department of Orthopedics, J. J. Hospital, Mumbai, Maharashtra, India
  • Pranay Kondewar Department of Orthopedics, J. J. Hospital, Mumbai, Maharashtra, India
  • Syed Rahman Hifzur Department of Orthopedics, Shatabadi Hospital, Mumbai, Maharashtra, India
  • Sushant Shrivastava Department of Orthopedics, Shatabadi Hospital, Mumbai, Maharashtra, India
  • Ninad Kale Department of Orthopedics, Shatabadi Hospital, Mumbai, Maharashtra, India



Complex acetabular fractures, Combined approach, Plate fixation, Recon plate


Complex acetabular fractures described by Judet and Letournel present with a formidable diagnostic and therapeutic challenge. Simultaneous anterior and posterior exposures of the acetabulum are a safe and are useful alternative to other extensile exposures and can be performed with similar morbidity. The advantages of simultaneous anterior and posterior approaches over extensile exposures include less morbidity, less hospital stay, early mobilisation and avoidance of soft tissue contracture. The combined approach is most useful in transverse, transverse posterior wall fractures with wide anterior displacement, T type fractures with significant anterior-inferior displacement, or both column fractures with posterior wall involvement. 23-year-old male came with chief complaints of pain and swelling at right hip since 3 days. He had history of fall from train and then referred to us for further management. clinical and radiological assessment was done. Approachment of the case was done with combined anterior and posterior incision in single sitting. It provided excellent clinical and radiological outcome. Complex acetabular fracture is a challenging entity. Association of these fractures with complex anatomy, delicate soft tissue handling and extensive blood loss makes it more difficult to manage. Combined anterior and posterior approaches of aceatabulum in a single sitting can be used as safe alternative to step wise extensible approaches used routinely. Outcomes associated with single sitting are good as its associated with lesser morbidity of patient, early functional mobility and less hospital stay. Though it’s not devoid of its own complications decision must be taken depending upon the condition of the patient and surgeon’s choice.


Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632e45.

Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res. 1988;(230):83e97.

Meena UK, Tripathy SK, Sen RK, Aggarwal S, Behera P. Predictors of post-operative outcome for acetabular fractures. Orthop Traumatol Surg Res. 2013;99(8): 929e35.

Grubor P, Krupic F, Biscevic M, Grubor M. Controversies in treatment of acetabular fracture. Med Arch. 2015;69(1):16e20.

Crenshaw AH. Surgical techniques and approaches. In: Azar FM, Beaty JH, Canale ST, eds. Campbell’s operative Orthopaedics. 13th ed. Philadelphia PA, USA: Elsevier; 2017:86e92.

Griffin DB, Beaule PE, Matta JM. Safety and efficacy of the extended ilio-femoral approach in the treatment of complex fractures of the acetabulum. J Bone Joint Surg Br. 2005;87(10): 1391e6.

Wey J, DiPasquale D, Levitt L, Quitkin H. Operative treatment of acetabular fractures through the extensile Henry approach. J Trauma. 1999;46(2):255e60.

Dakin GJ, Eberhardt AW, Alonso JE. Acetabular fracture patterns: associations with motor vehicle crash information. J Trauma. 1999;47(6):1063-1071.

Giannoudis PV, Grotz MR, Papakostidis C. Operative treatment of displaced fractures of the acetabulum: a meta-analysis. J Bone Joint Surg Br. 2005;87(1):2-9.

Scheinfeld MH, Dym AA, Spektor M. Acetabular fractures: what radiologists should know and how 3D CT can aid classification. Radiographics. 2015;35(2): 555-77.

Alton TB, Gee AO. Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res. 2014; 472(1):35-8.

Judet R, Judet J, Letournel E. Fractures of the acetabulum: Classification and surgical approaches for open reduction preliminary report. J Bone Joint Surg Am. 1964;46(8):1615-75.

Letournel E. Acetabulum fractures: classification and management. Orthoped Trauma Direct. 2007;5(5):27-33.

Vas WG, Wolverson MK, Sundaram M, et al. The role of computed tomography in pelvic fractures. J Comput Assist Tomogr. 1982;6(4):796-801.

Kim JJ, Kim JW, Oh HK. The submuscular sliding plate technique for acetabular posterior wall fractures extending to the acetabular roof. Orthop Traumatol Surge Res. 2014;100(8):967-70.

Elmadağ M, Güzel Y, Acar MA. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surge Res. 2014;100(6):675-80.

Fishman EK. Protocols for helical CT of the musculoskeletal system. Helical (spiral) computed tomography: a practical approach to clinical protocols. New York, NY: Lippincott-Raven; 1998: 149-78.






Case Reports