Der TIMI(„two incision minimal invasive“)-Zugang für die Versorgung von Acetabulumfrakturen

Objective

We present the two-incision minimally invasive (TIMI) approach for the treatment of anterior acetabular fractures.

Indications

Displaced fractures of the anterior column of the acetabulum; complex fractures of the acetabulum in combination with the posterior approach (Kocher–Langenbeck); periprosthetic fractures of the acetabulum with or without additional revision of the cup.

Contraindications

Possibly previous extended surgery in the anatomical region of the approach.

Surgical technique

The first TIMI incision is performed by an alternate cut through at the level of the proximal third of the pelvic brim. After transection of the abdominal wall, the iliac vessels are mobilized medially and the neuromuscular bundle laterally. The second approach lies above the medial pubic bone. The soft tissue is held using a retraction system. After fracture reduction and fixation by isolated screws, a reconstruction plate is inserted for fracture neutralization.

Postoperative management

Depending on the fracture type and the severity of the damage to the acetabular dome, the involved extremity is allowed partial weight bearing for 6 weeks to 3 months.

Results

In our experience, a relatively short operation time of approximately 1.5–2 h for acetabular osteosynthesis. Wound infections and revisions are very rare. Radiological follow-up shows an anatomical result in over 75% of cases. The 24-month follow-up examination shows a Harris Hip Score of over 85 points. The quality of life measured by the EQ 5D is comparable to the quality of life of a normal collective of the same age.