Anterior Approach to Acetabulum

Aims

  • LeTournel & Judet iliofemoral approach

Indications

Posterior Approach to Acetabulum, the acetabulum of the hip bone
The acetabulum of the hip bone. Image by Henry Gray and Henry Vandyke Carter, Wikimedia Commons, Public domain.
  • Anterior column fractures
  • Transverse fractures
  • Double column
    • Good exposure to part of posterior column

Contraindications

  • Posterior column fractures

Principles

  • Technically demanding
    • Occasional user
      • Predissection of cadaveric material
  • Large amounts of soft tissue stripping
    • Consider use of 2 approach techniques
      • Posterior
      • ilioinguinal

Position

  • supine

Landmarks

Incision

  • Curved longitudinal incision
  • Runs along the anterior half of the iliac crest to the ASIS
  • Then vertically down anterior thigh for 8 cm

Internervous Plane

Superficial Dissection

  • Deepen the incision
  • Being careful to avoid damaging the Lateral Femoral cutaneous nerve of the thigh
  • ER leg to stretch Sartorius to make it more prominent
  • Identify the gap between TFL & sartorius
    • Develop this plane
    • Superiorly near the ASIS
      • Ascending Branch of Lateral femoral circumflex artery must be ligated

Deep Dissection

  • Identify Rectus femoris & Gluteus medius
  • Strip gluteus medius from its origin by blunt dissection
  • Continue on this plane strips the origin of gluteus minimus as well
  • Continue as far posteriorly as necessary
  • To expose posterior column
    • Detach insertion of glutei from greater trochanter
      • Hardinge style
      • Trochanteric osteotomy
    • Beware injuring superior gluteal nerve & artery by prolonged stretch
  • To expose inner part of iliac wing
    • Detach origins of abdominal muscles from iliac crest
    • Reflect underlying iliacus by blunt subperiosteal dissection

Dangers

  • Nerves
    • Lateral femoral cutaneous nerve
    • Femoral nerve
  • Vessels
    • Ascending branch of lateral femoral circumflex artery
    • Superior gluteal artery
      • Emerge from greater sciatic notch
      • At high danger because origins & insertion of gluteals are detached

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.