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Pelvis & Acetabulum


Begin the skin incision at the middle of the iliac crest. Carry it anteriorly over the anterosuperior iliac spine and then distally along the medial border of the sartorius to the middle third of the anterior thigh. Divide the superficial and deep fascia. Develop the interval between the tensor fasciae latae laterally and the sartorius medially, exposing the rectus femoris. Divide the sartorius at its attachment to the anterosuperior iliac spine. Then divide the external branch of the lateral femoral cutaneous nerve. Incise the anterior abdominal musculature from the iliac crest and reflect it medially. Next, expose the iliac fossa by elevating the iliacus muscle. Carefully protect the femoral nerve and vessels and the remaining branches of the lateral femoral cutaneous nerve, which lie just medial to the plane of the dissection. Detach both origins of the rectus femoris and reflect the muscle medially to expose the anterior surface of the hip joint capsule and anterior wall of the acetabulum. The iliopsoas tendon can be divided to provide more access to the anterior column. Preserve the musculature on the external surface of the iliac wing in this approach. Further reflection of the iliacus and abdominal musculature posteriorly and medially allows exposure of the inner wall of the ilium to the sacroiliac joint. Anteriorly, the superior pubic ramus can be exposed but not the symphysis pubis.

Letournel modified and improved the Smith-Petersen, or iliofemoral, approach. The muscles on the inner wall of the ilium are elevated to gain access to the anterior column directly within the pelvis.

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