Acetabular Fracture Fixation Via a Modified Stoppa Limited Intrapelvic Approach Description of Operative Technique and Preliminary Treatment Results

Quadrilateral plate fractures of the acetabulum: An update

“…18,41 The most widely used functional scoring systems are the Merlé D'Aubingné -Postel and the Harris hip scores; others include the SF-12, SF-36 and the Musculoskeletal Functional Assessment. 3,11,18,27,42,43,[46][47][48] …”

“…22 The surgical approach to quadrilateral plate fractures is dependent on the fracture pattern, whether the quadrilateral plate remains attached to one of the columns or is a separate displaced or comminuted fragment, the column or wall which appears mostly displaced, the planned method of fixation, as well as the surgical expertise and preference. 10,47 A full discussion of operative approaches is beyond the scope of this review. Some early attempts at fixation of quadrilateral plate fractures attributed their failure to an incorrect approach being chosen, 34 which highlights the importance of careful preoperative planning.…”

“…3,4 There has been a move away from extensile approaches such as the extended iliofemoral, triradiate and dual approaches due to an increased rate of complications especially in the elderly. 3,4,18,21,29,42,47,78,79 The ilioinguinal approach, first described by Letournel, has been the most widely used intrapelvic approach to access fractures of the quadrilateral plate. It has a relatively low complication rate but it can be associated with injury to the iliac vessels and lymphatics, lateral femoral cutaneous nerve and disruption of the inguinal ligament resulting in post-operative hernia.…”

“…It has a relatively low complication rate but it can be associated with injury to the iliac vessels and lymphatics, lateral femoral cutaneous nerve and disruption of the inguinal ligament resulting in post-operative hernia. 3,29,42,47 More recently alternative approaches, advantageous to the reduction and fixation of the quadrilateral plate have been described, including the Stoppa approach. 3,29,42,45,47 Keel et al 39 have recently described the pararectus surgical approach.…”

“…2) through the modified Stoppa approach for fractures involving the quadrilateral plate with medial displacement of the femoral head was a later proposition. 10,11,47 The plate is attached securely posteriorly using screws placed superior to the sciatic notch and anteriorly to the superior pubic ramus along the infrapectineal line. This buttresses the quadrilateral plate in the same plane as the displacement rather than perpendicular to it, helping to prevent protrusio.…”