A modification of the extended iliofemoral incision of Letournel and
Judet facilitates the operative exposure of T-type, complex transverse, and
both-column acetabular fractures and malunions. The modification includes
the utilization of a T-shaped skin incision with large flaps, and
osteotomies of the iliac crest, greater trochanter, and anterior superior
iliac spine. The iliotibial band is transected and the abductor muscle mass
is rotated posteriorly, hinged on the superior gluteal neurovascular
bundle. Twenty patients had open reduction and internal fixation of a
complex acetabular fracture using this surgical approach. Excellent
surgical exposure allowed good or excellent reduction of the acetabulum in
all patients. No flap necrosis developed, and all fractures healed. One
non-union of a trochanteric osteotomy needed revision. This approach
provides increased exposure of the posterior column and visualization of
the entire surface of the joint and it allows fixation of the fracture from
both sides of the iliac wing. The T-shaped skin incision allows utilization
of a standard posterior approach with conversion to the extensile exposure
if necessary. Options for late reconstruction are not compromised. Lagscrew
fixation of the osteotomies allows aggressive rehabilitation of the
joint.