Management of anterior associated types of acetabular fractures utilizing the modified Stoppa and the pararectus approaches: a prospective cohort study and early experience from a level one Egyptian trauma centre

Fergany, Ali; Khalifa, Ahmed A.; Mohamedean, Aly; Adam, Faisal; Farouk, Osama

doi:10.1007/s00264-021-05293-x

“…Second, some surgeons manually perform hip joint distraction or insert a lateral traction pin through the femoral neck, which is also practiced in our unit [ 42 ]. This could lead to a relatively inconsistent joint distraction and undue traction of the whole patient from the operative Table [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Efficient hip joint distraction using the AO large femoral distractor in treating acetabular fractures associated with marginal impaction and intraarticular incarcerated fragments

Badran,

Khalifa,

Fergany

et al. 2024

BMC Musculoskelet Disord

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Purpose The results after acetabular fracture are primarily related to the quality of articular reduction. Using the AO large femoral distractor, incarcerated fragments can be easily removed, and marginally impacted fragments can be elevated under direct visualization without further re-dislocating the joint. The current study aimed to evaluate our early results of using the AO large femoral distractor as an assisting tool during ORIF of acetabular fractures associated with marginal impaction or intraarticular incarcerated fragments. Methods Eighteen patients were included in this retrospective case series study diagnosed with an acetabular fracture associated with either marginal impaction injury or an intraarticular incarcerated fragment. On a usual operative table, all patients were operated upon in a prone position through the Kocher Langenbeck approach. The AO large femoral distractor was used to facilitate hip joint distraction. Postoperative fracture reduction and joint clearance were assessed in the immediate postoperative CT scans. Results The average age of the patients was 30 ± 8.2 years; 13 (72.2%) were males. All cases had a posterior wall fracture, and it was associated with transverse fractures, posterior column fractures, and T-type fractures in five (27.8%), two (11.1%), and one (5.6%) patients, respectively. Intraarticular incarcerated fragments were present in 13 (72.2%) cases and marginal impaction in five (27.8%). Fracture reduction measured on the postoperative CT scans showed an anatomical reduction in 14 (77.8%) patients, imperfect in four (22.2%), and complete clearance of the hip joint of any incarcerated fragments. Conclusion The use of the AO large femoral distractor is a reliable and reproducible technique that can be applied to assist in the removal of incarcerated intraarticular fragments and to ease the reduction of marginally impacted injuries associated with acetabular fractures.

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“…14 Shazar et al analyzed 103 patients with acetabular fracture who were treated using the Pfannenstiel incision in the modified Stoppa approach and reported that the quality of reduction was anatomic in 82.5% (85), imperfect in 14.5%, 15 and poor in 2.9%. 3,20 In a prospective study, Fergany et al 21 evaluated 43 patients who underwent treatment with the modified Stoppa approach using the Pfannenstiel incision for acetabular fractures. They concluded that the quality of fracture reduction in the early postoperative period was anatomical in 81% and imperfect or poor in 19%.…”

Section: Discussionmentioning

confidence: 99%

“…Only 1 patient with obturator nerve paralysis in group P did not improve, and other patients with nerve palsy improved in an average of 6 months. In addition, most authors reported 1%-5% external iliac vein injury, 11,14,30 1.8% bladder injury, 31 3.6-8% DVT, 14,21 1.1% intraarticular screw penetration, 33 and 1.8% inguinal hernia 31 in the treatment of acetabular fractures. In the current study, there was no significant difference between the 2 groups in the types of complications, which is consistent with the literature.…”

Section: Discussionmentioning

confidence: 99%

Vertical versus Pfannenstiel incision modified Stoppa approach in the treatment of acetabular fractures

Kara,

Elmadag,

Ali

et al. 2023

Journal of Orthopaedic Trauma

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OBJECTIVES: To compare the patient and fracture characteristics, radiological, functional, and quality of life outcomes, the need for a lateral window approach and requirement of total hip arthroplasty (THA), and complications in patients with simple and complex acetabular fractures who underwent a modified Stoppa approach through vertical and Pfannenstiel incisions. METHODS: Design: Retrospective comparison study Setting: Level one trauma center Patient Selection Criteria: Patients with acetabular fractures (OTA/AO type 62A-B-C) treated with vertical (Group V) or Pfannenstiel (Group P) incision modified Stoppa approach between 2010 and 2020. Outcome Measures and Comparisons: Patient characteristics, radiological evaluations (reduction quality and posttraumatic osteoarthritis), patient functional outcomes (SF-12 PCS, SF-12 MCS, HHS, and Merle d'Aubigne Apostel), approach modifications and stratification by fracture type and complications were compared between those treated with vertical or Pfannenstiel incisions. RESULTS: 104 patients (mean age of 38.5 ±14.3 year) were included. There was no significant difference between the Pfannenstiel or vertical groups regarding patient and fracture characteristics (p = 0.137), postoperative reduction quality (p = 0.130), or the mean functional and quality of life outcome scores at the last follow-up (p = 0.483 for HHS, p = 0.717 for Merle d'Aubigne Apostel score, p = 0.682 for SF-12 PCS, and p = 0.781 for SF-12 MCS). In group P, significantly more patients needed additional lateral incisions (40.8% vs. 10.9%; p 0.001) and total hip replacement procedures (12.2% vs. 1.8%; p = 0.049). The total, early, and late complication rates were significantly higher in group P (p 0.001, p = 0.034, and p = 0.049, respectively). CONCLUSION: Pfannenstiel incision was associated with higher complication rates than vertical incision in acetabular fractures treated through a modified Stoppa approach. Fracture complexity is associated with the need for a lateral window approach and THA, as well as a worse functional and radiological outcome regardless of incision type. However, it was not associated with the development of intraoperative or postoperative complications.

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“…As the patients' age increased, their prognosis became worse and worse, but they still had a high excellent and good rate. Ali et al reported 21 cases of elderly acetabular fractures involving the tetragonal area [ 26 ]. Although the anatomic reduction rate was only 52.4%, the SF-12PCS and Harris scores were satisfactory after an average follow-up of 4.2 years.…”

Section: Discussionmentioning

confidence: 99%

Effects of Different Surgical Procedures on the Therapeutic Effects, Prognosis, and Major Complications of Acetabular Fractures in the Elderly of China: A Systematic Review and Meta-Analysis

Li

¹

,

Liu

²

,

Chen

³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. Different surgical approaches were systematically evaluated to provide an evidence-based medical rationale for the application and promotion of acetabular fractures in the elderly of China. Methods. Randomized controlled trials (RCT) of different surgical methods in the treatment of elderly acetabular fractures were searched in the PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM). The search time threshold was set from the time the database was created to the current time. Investigators obtained data independently, and the bias risk of each included writing was reviewed using the Cochrane Manual 5.1.0 criterion. The meta data was analyzed using RevMan 5.4 statistical package. Results. 6 RCT articles were included in the end. A total of 445 samples were analyzed by meta. All the six RCT literatures included in this meta-analysis reported the baseline status of patients, only 3 RCT mentioned “random assignment” without any explanation, and the rest did not mention “random” information. The five studies included all gave detailed intervention measures. The number and reasons of blind method and lost follow-up or withdrawal were not described in detail in 6 RCT articles. Through the meta-analysis excellent and good rate between the experimental group and the control group through 6 RCT studies, the heterogeneity test results were ch i 2 = 6.11 , df = 4 , P = 0.19 > 0.05 , and I 2 = 35 % , without obvious heterogeneity at Z = 2.68 and P = 0.007 . These results suggested that the total hip arthroplasty application has the same excellent rate as other surgical treatment methods, indicating that total hip arthroplasty has a significant effect on the treatment of elderly acetabular fractures. Through the meta-analysis hip-joint function score, the heterogeneity test results were ch i 2 = 56.16 , df = 4 , P < 0.00001 , and I 2 = 93 % , with obvious heterogeneity. The great difference was discovered in hip function score between total hip arthroplasty and other surgical methods, showing that total hip arthroplasty can greatly improve hip-joint function. Then, the incidence of hip complications between the experimental cases and the control cases was calculated by meta. The heterogeneity test results were ch i 2 = 3.17 , df = 4 , P = 0.53 > 0.05 , and I 2 = 0 % , without remarkable heterogeneity at Z = 3.05 and P = 0.002 . This demonstrated that a significant difference was observed in the complication incidence, indicating that total hip arthroplasty displayed a lower incidence of hip-joint functional complications. Conclusion. Total hip arthroplasty has a good prognosis and a low complication rate in the treatment of acetabular fractures in the elderly. However, more studies and longer follow-ups are needed to further validate the findings of this study.

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Management of anterior associated types of acetabular fractures utilizing the modified Stoppa and the pararectus approaches: a prospective cohort study and early experience from a level one Egyptian trauma centre

Cited by 10 publications

References 36 publications

Efficient hip joint distraction using the AO large femoral distractor in treating acetabular fractures associated with marginal impaction and intraarticular incarcerated fragments

Efficient hip joint distraction using the AO large femoral distractor in treating acetabular fractures associated with marginal impaction and intraarticular incarcerated fragments

Vertical versus Pfannenstiel incision modified Stoppa approach in the treatment of acetabular fractures

Effects of Different Surgical Procedures on the Therapeutic Effects, Prognosis, and Major Complications of Acetabular Fractures in the Elderly of China: A Systematic Review and Meta-Analysis

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