Pelvic, acetabular, hip, and proximal femur fractures: Surgical exposures and treatment of nerve injury

The treatment of pelvic and acetabular fractures is a challenging area of orthopedic surgery, owing to the significant technical learning curve, and complexity of surgical dissection and exposures. An important step toward achieving a good long-term clinical outcome in these patients is an anatomical reduction of these injuries. This requires an elegant and careful dissection to obtain adequate surgical exposure in order to safely complete the surgery. There are a number of classic approaches to the pelvis and acetabulum that are familiar to orthopedic surgeons, and choosing the correct approach requires a thorough understanding of the fracture pattern because no single approach will allow the surgeon access to the entire acetabulum. The neuroanatomy of the pelvis is very complex, and without an intimate understanding of the relationship between bony structures and neighboring neurovasculature, the risk of inadvertent injury remains high, and may lead to poor surgical outcomes.