Objectives: To present a novel two-incision minimally invasive (TIMI) method for the treatment of anterior acetabular fractures.
Design: Prospective consecutive case series.
Setting: Level I University Trauma Centre.
Patients: Twenty-six patients (mean age, 67 ± 19 years).
Intervention: The first TIMI-incision is performed by 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 using a retraction system. After fracture reduction and fixation by isolated screws, a conventional reconstruction plate is inserted for fracture neutralization.
Main outcome measurements: Perioperative course, postoperative radiological evaluation, functional outcome Harris hip score, and quality of life (EQ 5D).
Results: Mean operative time was 109 ± 30 mins. All incisions healed primarily. Postoperative radiological exam 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 Harris hip score was 86,6 ± 8. Quality of life was comparable to persons in the same age group.
Conclusion: The TIMI approach represents a viable alternative to the ilioinguinal approach. Despite the limited incisions, a comparable quality of fracture reduction is achieved. The authors believe this technique would be most useful in those patients with a higher risk for postoperative soft-tissue complications.
Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.