Acute total hip replacement by direct anterior approach combined with intrapelvic fixation for geriatric acetabular fracture of the anterior column

Management of anterior column acetabular fracture in the elderly is challenging. Open reduction and internal fixation do not allow early weight bearing and are associated with a high risk of failure compared to younger patients. Therefore, acute fixation and total hip arthroplasty may be an option. This technical note describes a combined procedure: anterior intrapelvic approach for fracture fixation and a direct anterior approach to the hip for THR. Fracture reduction and arthroplasty were achievable in all five patients. The mean operative time was 289 min, and the mean blood loss was 2120 mL. At short term, no complication was noticed. Combining these two "muscle-sparing" approaches could help manage anterior column fractures in elderly patients. Level of evidence: IV. (c) 2023 Elsevier Masson SAS. All rights reserved.