ORIGINAL ARTICLE Comparison of Acetabular Fracture Reduction Quality by the Ilioinguinal or the Anterior Intrapelvic (Modified Rives–Stoppa) Surgical Approaches Nachshon Shazar, MD,*† Iris Eshed, MD,†‡ Nissim Ackshota, MD,* Oded Hershkovich, MD, MHA,* Alexander Khazanov, MD,§ and Amir Herman, MD, PhD*†k Objective: To compare the reduction quality, surgery time, and early postoperative complications between the 2 following surgical approaches: the ilioinguinal and the anterior intrapelvic (AIP or modified Rives–Stoppa). Design: Retrospective study. Patients: Comparison of 122 patients operated in our center between 1996 and 2003 with the ilioinguinal approach and 103 cases operated between 2004 and 2011 with the AIP approach. Setting: Level 1 trauma center, acetabular fracture surgery referral center. Outcome Measurement: The patients’ demographics, fracture type, fracture reduction quality, surgery time, and postoperative complications were compared. Results: Anatomic reduction was achieved in 84 patients (68.9%) treated by the ilioinguinal approach and in 85 patients (82.5%) treated by the AIP approach (P = 0.018). In both the columns, acetabular fracture type anatomic reduction was achieved in 54.2% of the ilioinguinal group and 79.4% of the AIP group (P = 0.018). In the ilioinguinal group, surgery time decreased as the number of surgeries increased (P = 0.021), whereas a similar trend was not found in the AIP group. Fracture type distribution and complication rates were similar for both the groups. Conclusions: The AIP approach is a safe alternative that offers better exposure and possibly improved reduction quality of acetab- ular fractures compared with the ilioinguinal approach. We believe that the major advantage of the AIP approach is that it enables reduction of the posterior column and the quadrilateral plate from the contralateral side and enables application of a buttress plate below the pelvic brim. Key Words: acetabular fracture, ilioinguinal, modified Stoppa, surgical approach Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. (J Orthop Trauma 2014;28:313–319) INTRODUCTION Reductions of acetabular fractures are among the most challenging surgical objectives encountered by orthopaedic surgeons. It is widely accepted that anatomic reduction of the fracture and reconstruction of joint congruency comprise the cornerstone of treatment. Matta 1 demonstrated that anatomic reduction managed operatively leads to better clinical outcome. The pioneering works of Judet et al 2 and of Letournel 3 have standardized both the classification and operative manage- ment of acetabular fractures. Letournel and Judet developed the ilioinguinal approach, which was later adopted by many others as the principal anterior surgical approach for open reduction and internal fixation of acetabulum fractures. 2–16 Anatomic reduction rates following that procedure were reported as ranging between 45% and 74%. 5,14 Rives et al 17 and Stoppa et al 18 first described the use of an intra-abdominal surgical approach for the repair of groin hernias. Cole and Bolhofner 19 reported the use of a modi- fication of that surgical approach for open reduction and internal fixation of acetabular fractures. Successful anatomic reduction rates were reported to range from 59% to 82% of the cases. 20–25 Both the ilioinguinal and the anterior intrapelvic (AIP or modified Rives–Stoppa) approaches are used for similar fracture patterns when anterior access is needed, such as in anterior column, both columns, anterior column posterior hemi-transverse, transverse, and T-type fractures. 5,14,20,21,25 Neither of them, however, can be used alone for fractures in which the posterior acetabular wall needs to be reduced and fixed. 20,26 We compared the perioperative results of open reduction internal fixation of acetabular fractures operated by the ilioinguinal approach with the AIP surgical approach. Our specific aims were to compare their anatomic reduction qual- ity, surgery time, and early postoperative complication rates. PATIENTS AND METHODS Between 1996 and 2011, 397 patients underwent surgery in our department for open reduction and internal fixation by Accepted for publication September 5, 2013. From the *Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel; †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Departments of ‡Imaging and §Anesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel; and kTalpiot Medical Leader- ship Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel. Presented in part as a poster presentation at the Annual Meeting of the Orthopaedic Trauma Association, October 2012, Minneapolis, MN. The authors report no funding or conflict of interest. Reprints: Amir Herman, MD, PhD, Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel (e-mail: amirherm@gmail.com). Copyright © 2013 by Lippincott Williams & Wilkins J Orthop Trauma  Volume 28, Number 6, June 2014 www.jorthotrauma.com | 313