This article describes a novel approach, the Direct Posterior Approach (DPA) for the treatment of posterior acetabular fractures (posterior column, posterior wall, or both posterior column and wall). This technique allows direct visualization of the entire posterior wall, part of the hip capsule and the posterior column between the space of the gluteus medius and the piriformis superiorly. The approach spares the division of short external rotators, abductors, and hip capsule, thus preventing iatrogenic damage to the medial femoral circumflex artery, sciatic nerve, and superior and inferior gluteal neurovascular bundles, as well as protecting the vascularity of the fracture fragments. In addition to the low blood loss, short operative time and low risk of iatrogenic injury, patients who are treated by the DPA approach exhibit positive functional recovery in follow-up. DPA is an effective, safe and minimally-invasive technique for the treatment of posterior acetabular fractures.
Keywords: Direct Posterior Approach; acetabular fractures; posterior column; posterior wall; surgical technique.