**6. Surgical approach for each fracture pattern**

One of the most important aspect of the preoperative planning for acetabular fracture surgery is the selection of appropriate surgical approach [23, 24]. The main determinants in the decision-making process are the type of fracture, the elapsed time from injury to operative intervention, and the magnitude and location of maximal fracture displacement. The mainstay surgical approaches to the acetabulum are those described by Letournel and Judet (**Table 2**):

**17**

*Surgical Anatomy of Acetabulum and Biomechanics DOI: http://dx.doi.org/10.5772/intechopen.92330*

**Fracture pattern Approach**

Posterior wall Kocher-Langenbeck Posterior column Kocher-Langenbeck Anterior wall Ilioinguinal or iliofemoral Anterior column Ilioinguinal or iliofemoral

Posterior column + posterior wall Kocher-Langenbeck

Anterior column + posterior hemitransverse Ilioinguinal

Transverse Kocher-Langenbeck or ilioinguinal

T-shaped Extended iliofemoral or combined

Transverse + posterior wall Extended iliofemoral or Kocher-Langenbeck

Both columns Ilioinguinal or extended iliofemoral or combined

• The Kocher-Langenbeck

*Surgical approaches used for various fracture patterns.*

• The extended iliofemoral

**6.1 Modified Stoppa approach**

**7.1 Normal mechanics of the hip joint**

of the problems confronting the orthopedic surgeon.

General agreement exists for the use of the modified Stoppa approach for all fractures that can be managed with an ilioinguinal approach [24]. This includes anterior wall, anterior column, and associated anterior column and posterior hemi transverse fractures, as well as certain both- column, T-shaped, and transverse fractures. The Stoppa approach is particularly useful for fractures that involve the quadrilateral surface with or without comminution and medial dislocation of the femoral head.

**7. Biomechanics of the acetabulum and applied mechanics of fracture** 

Of the many joints in the human body, the hip joint has been the one which has attracted the most attention from investigators [26, 27]. The reasons are; first, in normal activity this joint carries the greatest load, load intensity fluctuating between zero and its maximum during each cycle of activity; secondly, probably because of this loading, mechanical failures of the hip joint and of the neighboring bony structure, particularly the upper femoral region, constitute a large proportion

• The ilioinguinal

**Elementary**

**Associated**

**Table 2.**

• The iliofemoral

**fixation**


#### **Table 2.**

*Essentials in Hip and Ankle*

• Transverse

**Figure 12.**

*column fracture.*

• T-shaped

• Both columns

Associated fractures

• Posterior column + wall

• Transverse + posterior wall

• Anterior + posterior hemitransverse

**6. Surgical approach for each fracture pattern**

lum are those described by Letournel and Judet (**Table 2**):

One of the most important aspect of the preoperative planning for acetabular fracture surgery is the selection of appropriate surgical approach [23, 24]. The main determinants in the decision-making process are the type of fracture, the elapsed time from injury to operative intervention, and the magnitude and location of maximal fracture displacement. The mainstay surgical approaches to the acetabu-

*Associated fractures: (F) Posterior column and posterior wall fracture, (G) Transverse and posterior wall fracture, (H) T-shaped fracture, (I) Anterior column and posterior hemitransverse fracture (J) Complete both* 

**16**

*Surgical approaches used for various fracture patterns.*


### **6.1 Modified Stoppa approach**

General agreement exists for the use of the modified Stoppa approach for all fractures that can be managed with an ilioinguinal approach [24]. This includes anterior wall, anterior column, and associated anterior column and posterior hemi transverse fractures, as well as certain both- column, T-shaped, and transverse fractures. The Stoppa approach is particularly useful for fractures that involve the quadrilateral surface with or without comminution and medial dislocation of the femoral head.
