Comparison of Acetabular Fracture Reduction Quality by the Ilioinguinal or the Anterior Intrapelvic (Modified Rives–Stoppa) Surgical Approaches

Shazar, Nachshon; Eshed, Iris; Ackshota, Nissim; Hershkovich, Oded; Khazanov, A. M.; Herman, Amir

doi:10.1097/01.bot.0000435627.56658.53

Cited by 91 publications

(123 citation statements)

References 31 publications

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“…We evaluated the baseline data in the 2 groups and noted a larger degree of preoperative dislocation of the acetabular roof in the 3D group, and similar distribution between the 2 groups with respect to fracture type, age, and sex. The baseline parameters were comparable to those in the other acetabular fracture studies reported in this manuscript (Briffa et al 2011, Oberst et al 2012, Tannast et al 2012, Shazar et al 2014). Propensity score methods are an option to reduce potential bias between trial arms in non-randomized trials.…”

Section: Discussionsupporting

confidence: 81%

“…The duration of the operations aided by 3D imaging was 167 min—not longer than the operations before introduction of the O-arm and shorter than the duration of 264 min reported by Oberst et al (2012) and the 242 min reported by Shazar et al (2014). The surgical site infection rates was 4 out of 42 in the control group and 4 out of 72 in the 3D group, which is similar to the infection rate of 18/161 (11%) reported by Briffa et al (2011) and 17/122 (7%) reported by Shazar et al (2014). Late-occurring infections may have escaped our notice because patients were transferred to their local hospital, usually 1 week postoperatively.…”

Section: Discussionmentioning

confidence: 78%

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Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

2015

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Background and purpose — During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation.Patients and methods — We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction was evaluated on reconstructed coronal and sagittal images of the acetabulum.Results — The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0.4) had a perfect result. The mean difference in postoperative articular incongruity was 0.5 mm (95% CI: 0.4–0.7). In 29 of 72 operations, the intraoperative 3D scans led to intraoperative correction of the reduction and an improved result. The duration of surgery and infection rate were similar in the 2 groups.Interpretation — Intraoperative 3D imaging, which is not time-consuming, allowed the surgeon to correct malreductions and screw placement in 29 of 72 operations, leading to better articular reduction and more precise screw placement than in operations where conventional fluoroscopic imaging was used to control the reduction.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 78%

Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

2015

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“…An extension of the approach was infrequently used (1st window ilioinguinal approach in 2%, mini-incision at the iliac crest in 21%) whereas the modified Stoppa approach was frequently used with the combination of the 1st window of the ilioinguinal approach [8] (55-93% [10,14,17,[19][20][21]) or others [9,13,15] described this combination as their standard procedure. Furthermore, the Pararectus approach allows (1) clear visualisation of the fracture without the need to change either the surgical window or the position, (2) access to the anterior wall, (3) secure access to the 2nd window, and facilitates (4) a skin incision in cases with suprapubic bladder catheters in situ (one patient in the presented series) or (5) various directions of posterior column screws without the need for an additional 1st window of the ilioinguinal approach.…”

Section: Parametermentioning

confidence: 99%

“…In contrast to the modified Stoppa approach, a relevant extension of the Pararectus approach was almost not necessary. anatomic reduction was achieved more frequently by utilisation of the modified Stoppa approach compared to the ilioinguinal approach [20] as well as a reduced intraoperative blood loss and a shortened operative time [21]. Also, the Pararectus approach has been introduced as a lessinvasive, single-incision approach which combines the advantages of the ''second and third windows'' of the ilioinguinal approach with the medial view of the modified Stoppa approach [22].…”

Section: Introductionmentioning

confidence: 99%

Clinical results of acetabular fracture management with the Pararectus approach

Keel¹,

Tomagra²,

Bonél³

et al. 2014

Injury

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In the treatment of acetabular fractures involving the anterior column the Pararectus approach allowed for anatomic restoration with minimal access morbidity. Results obtained by means of the Pararectus approach after two years at least parallel those reported after utilisation of the modified Stoppa approach. In contrast to the modified Stoppa approach, a relevant extension of the Pararectus approach was almost not necessary.

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“…Moreover, the application of a plate to the quadrilateral surface is feasible in the Stoppa approach, and this facilitates anatomic reduction 15, 16. In addition to anatomic reduction, decreased intraoperative blood loss and shorter operating times have been reported with the modified Stoppa approach 15, 16, 17…”

Section: Introductionmentioning

confidence: 99%

Treatment results for acetabulum fractures using the modified Stoppa approach

Kılınç¹,

Acan²,

Gültaç³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectivesThe aim of this study was to evaluate the clinical and radiological results of the surgical treatment of acetabular fractures using modified Stoppa approach.MethodsA total of 57 patients (mean age 37.8 years; range 15–84) who underwent surgical treatment for acetabular fracture with modified Stoppa approach from February 2013 to June 2016 were included into the study. The mean follow-up time was 28.1 months (range 24–35). The records were reviewed for fracture patterns, time to surgery, operative time, blood loss, reduction quality, and perioperative complications. Reduction quality was graded as anatomic, imperfect, or poor. The Harris Hip Score (HHS) and Merle d'Aubigné score were used for functional evaluation.ResultsAmong the 63 acetabulum fractures of the 57 patients, 27 were associated with both columns, 12 were T-type fractures, 10 were transverse, 7 were anterior column/posterior hemitransverse, 5 were anterior column, and 2 were anterior wall fracture. A single surgeon performed all operations. Pfannenstiel incision was used in the first 19 cases while vertical midline incision in the remaining 38 cases. Average time to operation was 5.5 days, and supplemental lateral windows were used in 17 (29.8%) patients. Average blood loss and operation times were 660 mL and 152 min, respectively. Radiological outcomes were anatomic, imperfect, and poor in 52 (82.5%), 9 (14.2%), and 2 (3.2%) of the acetabulum fractures, respectively. Clinical outcomes at 2 years with HHS and Merle d’Aubigné scores were mean 86.6 (range 66–96) (Excellent in 27, good in 23, fair in 4, poor in 3 patient) and 16.7 (range 10–18) (Excellent in 25, very good in 18, good in 6, fair in 5, poor in 3 patient), respectively. There was a significant relation between the reduction quality and clinical outcome (p < 0.001), while there was no significant relation between the clinical outcome and the fracture type (p > 0.05). Iatrogenic external iliac vein damage was noted in 2 patients. Obturator nerve palsy was noted in 3 patients, who recovered spontaneously at mean time of 3.7 months (range 3–5). Rectus abdominus paralysis was noted in 2 of the 19 (10.5%) Pfannenstiel-incision patients but not in the vertical-incision patients.ConclusionOur experience in 57 patients shows that satisfactory results can be obtained, even in bilateral fractures with vertical midline incision.Level of evidenceLevel IV Therapeutic Study

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Comparison of Acetabular Fracture Reduction Quality by the Ilioinguinal or the Anterior Intrapelvic (Modified Rives–Stoppa) Surgical Approaches

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 91 publications

References 31 publications

Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

Clinical results of acetabular fracture management with the Pararectus approach

Treatment results for acetabulum fractures using the modified Stoppa approach

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