Management of Fractures Involving Both Columns of the Acetabulum by Single AIP Approach with ASIS Osteotomy: A Case Series of 15 Patients

Abstract

Background: Fractures involving both columns of the acetabulum are complex injuries that demand precise anatomical restoration to achieve optimal functional outcomes. Conventional approaches, such as the ilioinguinal and Kocher-Langenbeck, have limitations in terms of exposure and morbidity. The anterior intrapelvic (AIP) approach with an anterior superior iliac spine (ASIS) osteotomy has emerged as an effective technique, offering direct visualization of both columns and allowing for adequate reduction of the fracture fragments. Objective: This study aims to evaluate the outcomes of a single Anterior Intrusion Plate (AIP) approach combined with Anterior Superior Iliac Spine (ASIS) osteotomy in managing these fractures. Methods: This prospective observational study was conducted over 12 months at a tertiary trauma care center and included 15 patients with acetabular fractures involving both columns. Patients underwent surgery using the anterior intrapelvic (AIP) approach with anterior superior iliac spine (ASIS) osteotomy. Inclusion criteria consisted of patients aged 18–65 with radiographically confirmed both-column acetabular fractures. Exclusion criteria included prior hip surgeries, neurovascular injuries, pathological fractures, open fractures, and severe polytrauma. Clinical outcomes were assessed using the Harris Hip Score (HHS) and Visual Analog Scale (VAS), while radiological outcomes were evaluated using Matta’s criteria. Data were analyzed using paired t-tests, with a significance level set at p < 0.05. Results: A total of 15 patients (mean age: 35.6 years) with acetabular fractures involving both columns underwent surgical treatment using the anterior intrapelvic (AIP) approach with ASIS osteotomy. The majority (73.33%) sustained injuries from motor vehicle accidents. Surgery was performed within an average of 5 days post-injury. Anatomical reduction was achieved in 80% of patients, with a mean operative time of 165 minutes and an average blood loss of 550 mL. At the 6-month follow-up, all patients showed radiographic evidence of fracture healing. The Harris Hip Score (HHS) improved significantly from a mean preoperative score of 48.2 to 88.4 postoperatively (p < 0.001), and the Visual Analog Scale (VAS) score decreased from 7.8 to 2.4 (p < 0.001). Two patients developed heterotopic ossification (Brooker Grade I), but no cases of deep vein thrombosis, surgical site infections, or neurovascular injuries were observed. 86.7% of patients returned to their pre-injury activity levels, with only 13.3% reporting mild functional limitations. Conclusion:  The anterior intrapelvic (AIP) approach combined with anterior superior iliac spine (ASIS) osteotomy is an effective and safe method for managing acetabular fractures involving both columns. This technique provides excellent surgical exposure, allows for precise fracture reduction, and results in significant improvements in pain, function, and overall patient outcomes. The low complication rate and high return to pre-injury activity levels support its use in these complex fractures.