Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated Using an Ilioinguinal Exposure

Document Type : RESEARCH PAPER


1 Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle, WA USA

2 Orthopedic and Trauma Service of Oklahoma, Tulsa, OK USA

3 Department of Orthopaedics Surgery, The University of Texas Medical School at Houston, Houston, TX USA


Purpose: Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon.
Methods: Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted.
Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized.
Results: Clinical Study- 5.7% (5/87) of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density.
Cadaver Study- 31% (11/36) of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28) compared to 16 mm (11-22) in normal cords, which was statistically significant.
Conclusion: The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.


  1. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res. 1993; 292(292):62-76.
  2. Routt MJ, Simonian PT, Swiontkowski M. Stabilization of pelvic ring disruptions. Orthop Clin North Am. 1997; 28(3):369-88.
  3. Routt ML Jr, Swiontkowski MF. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg Am. 1990; 72(6):897-904.
  4. Gilbert A. An anatomic and functional classification for the diagnosis and treatment of inguinal hernia. Am J Surg. 1989; 157(3):331-3.
  5. Bissada NK, Redman JF. Unusual masses in the spermatic cord: report of six cases and review of the literature. South Med J. 1976; 69(11):1410-2.
  6. Carilli S, Alper A, Emre A. Inguinal cord lipomas. Hernia. 2004; 8(3):252-4.
  7. Heller CA, Marucc DD, Dunn T, Barr EM, Houang M, Dos Remedios C. Inguinal canal “lipoma”. Clin Anat. 2002; 15(4):280-5.
  8. Lilly MC, Arregui ME. Ultrasound of the inguinal floor for evaluation of hernias. Surg Endosc. 2002; 16(4):659-62.
  9. Lilly MC, Arregui ME. Lipomas of the cord and round ligament. Ann Surg. 2002; 235(4):586-90.
  10. Nasr A, Tormey S, Walsh TN. Lipoma of the cord and round ligament: an overlooked diagnosis? Hernia. 2005; 9(3):245-7.
  11. Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed. Berlin: Springer Science & Business Media; 1993.
  12. Carbonell JF, Sanchez JL, Peris RT, Ivorra JC, Del Bano MJ, Sanchez CS, et al. Risk factors associated with inguinal hernias: a case control study. Eur J Surg. 1993; 159(9):481-6.
  13. van Wessem KJ, Simons MP, Plaisier PW, Lange JF. The etiology of indirect hernias: congenital and/or acquired? Hernia. 2003; 7(2):76-9.
  14. Irwin T, McCoubrey A. Adult groin hernias. Surgery. 2012; 30(2):290-5.