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A systemic review and meta-analysis of pararectus versus ilioinguinal approach for the management of acetabular fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The complex anatomy of acetabular fracture needs a surgical approach that can achieve anatomical reduction with fewer complications for the fixation of these fractures. Current literature suggests that both Pararectus (PR) approach and Ilioinguinal (IL) approach can be used for the fixation of these fractures safely. However, superiority of the PR approach over the IL approach is not established. Hence, this meta-analysis aimed to compare the PR versus IL approach.

Methodology

A literature search was performed on five databases Medline/PubMed, Scopus Embase, Cinhal, and Cochrane Library, from the inception to January 14, 2023. A qualitative and quantitative analysis was done for the five eligible studies from the literature search. Individual study characteristics data and outcomes were extracted, and Software version 5.4.1 of Review Manager was used for statistical analysis.

Results

Five articles, one Randomized trial (RCT), and four retrospective articles were included and analyzed in this meta-analysis. PR approach has a shorter surgical time [mean difference (MD) −48.4 with 95% CI −74.49, −22.30; p = 0.0003], less intraoperative blood loss (MD −123.22 with 95% CI −212.28, −34.15; p = 0.007), and smaller surgical incision (MD −9.87 with 95% CI −15.21, −4.52; p = 0.0003) than the IL approach. However, the meta-analysis failed to show a difference between the two surgical approaches concerning the quality of reduction, overall complications, nerve injury, vascular injury, heterotopic ossification, deep vein thrombosis, and pulmonary embolism.

Conclusion

The PR approach has a shorter surgical duration, less blood loss, and a smaller surgical incision than the IL approach. However, both surgical approaches have equivocal results regarding fracture reduction quality, complication rates, and functional outcomes for acetabular fracture fixation. Hence, for acetabular fractures fixation, PR approach can be considered a safe and feasible alternative to the IL approach.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, India

    Rajesh Kumar Rajnish, Abhay Elhence, Sandeep Kumar Yadav, Kuldeep Rathor & Saurabh Gupta

  2. Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India

    Amit Srivastava

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Contributions

RKR and AE were contributed to study design and conceptualization; SKY and RKR were contributed to data of extraction, analysis, and result interpretation; SA and KR were critically revising the article; and AE was contributed to final drafting and approval of the manuscript for final submission. All the above-mentioned authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

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Correspondence to Sandeep Kumar Yadav.

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Rajnish, R.K., Srivastava, A., Elhence, A. et al. A systemic review and meta-analysis of pararectus versus ilioinguinal approach for the management of acetabular fractures. Eur J Orthop Surg Traumatol 34, 549–560 (2024). https://doi.org/10.1007/s00590-023-03700-0

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