Modified Ilio-femoral approach: An update

Abstract

The iliofemoral approach, originally described by Judet in 1967, has undergone numerous modifications to enhance visualization and access to the anterior column, quadrilateral plate, and sacroiliac joint. The extended iliofemoral approach, introduced by Letournel, has been refined over the years to improve surgical outcomes while minimizing complications. This study provides an update on the modified iliofemoral approach and its advantages in managing acetabular and pelvic fractures. The modified iliofemoral approach involves the osteotomy of the anterior superior iliac spine thereby providing excellent visualization of key pelvic structures, improving reduction accuracy and fixation stability. Among the 353 cases, complications were minimal, with lateral femoral cutaneous nerve paresthesia observed in only 2 % of patients, ASIS osteotomy screw prominence requiring removal in 0.5 %, and deep surgical site infections in 4 %. No cases of heterotrophic ossification were reported. The modified iliofemoral approach offers a safe, effective, and versatile technique for addressing complex acetabular and pelvic fractures. Its ability to provide direct visualization of the sacroiliac joint, ilium, quadrilateral plate, and femoral head makes it a valuable alternative to the ilioinguinal and extended iliofemoral approaches. Additionally, its relatively lower risk of neurovascular injury and adaptability for both anterior and posterior pelvic injuries make it an ideal approach for young surgeons to master. Further studies are warranted to establish its role in contemporary pelvic surgery and optimize training protocols for its widespread adoption.