Modification of the Smith-Peterson iliofemoral
- allows exposure of the acetabulum & pelvis distal to the iliopectineal eminence
- allows access to the inner ilium, inner surface of the true pelvis & SIJ
- can also expose outer surface of ilium by releasing the abductors but compromises blood supply
- HO not usu seen unless release abductors
- does not allow access to hip joint unless acetabular Fracture
Indications
- pelvic fracture of anterior call or anterior column
- T type acetabular fractures
- periacetabular osteotomies
Position
- floppy lateral 0-30°
- drape to include contralat iliac crest
- IDC
Incision
- 2 limbs
- medial limb – 2-3cm above symphysis pubis to ASIS
- lateral limb – extends fro ASIS to beyond the Gluteus Medius tubercle of the iliac crest
Dissections
- start lateral & raise extension Oblique off iliac crest
- raise iliacus to expose SIJ
- medial limb
- extension oblique divide along & proximal to inguinal ligament to the extension inguinal ring
- spermatic cord [round ligament in F] is isolated & retracted medially
- inguinal canal is opened by opening the lower flap of extension oblique aponeurosis
- inferior epigastric a crossess the floor of the inguinal canal at the medial border of the deep inguinal ring & requires ligation
- LFCN needs to be identified & protected or transected transversalis fascia can then be incised [ leave flap for reattachment
- symphysis can be exposed by releasing rectus
- iliopectineal fascia is the key to access from the false to the true pelvis
- lateral to it is the femoral nerve
- medial to it is the extension iliac vessels
- use penrose drain around iliopsoas & femoral nerve
- use 2nd drain around extension iliac vessels
- exposure is then gained between these 3 mobile tissue envelopes
- retropubic space can be exposed by release of rectus