# Minimally Invasive Surgical Technique for the Extraperitoneal Fixation of Acetabulum Fracture: Technical Feasibility Study in Cadaver

## TL;DR

This study explores a minimally invasive surgical technique for fixing acetabulum fractures using extraperitoneal endoscopy, showing promise in cadaver trials.

## Contribution

The novel contribution is a minimally invasive endoscopic technique for acetabulum fracture fixation with extraperitoneal access, offering better visibility and access.

## Key findings

- The technique successfully enabled fixation and plating of the acetabulum in seven cadavers on both sides.
- The method provides superior visibility and easier access to the pelvic fracture site compared to traditional open surgery.
- Plate placement was feasible under combined endoscopic and fluoroscopic control in the cadaver model.

## Abstract

Background and Objectives: When operating on acetabular fractures in conventional open surgery, visualization of crucial structures can be challenging. In recent years there have been several case reports on laparoscopy-assisted acetabulum surgery in the literature. Therefore, we have developed this method further using extraperitoneal endoscopy to manage acetabulum fractures.

Methods: Operative technique: An experienced hernia surgeon familiar with the totally extraperitoneal laparoscopic technique facilitates access to the acetabulum area so that orthopaedic surgeons can focus on fixing the area with a plate and screws through laparoscopy ports.

Results: We developed this operative technique in a cadaver laboratory where we could easily fix and plate the acetabulum area with extraperitoneal endoscopy visualization in seven cadavers both on the left and right sides.

Conclusions: A minimally invasive full endoscopic procedure for acetabular fractures offers significant benefits over traditional open surgery due to faster rehabilitation, potentially less blood loss, and fewer wound complications. According to our initial experiences with cadavers, this minimally invasive method appears promising in terms of superior visibility and easier access to the otherwise narrow and difficult fracture site in the pelvic region compared to open surgery. Furthermore, this minimally invasive method seems feasible for exact plate placement under combined endoscopic and fluoroscopic visual control. The usefulness of this novel method in the minimally invasive treatment of acetabular fractures in real life, especially considering the practicality of proper fracture reduction, should be confirmed in future clinical trials.