Modified Medial Stoppa Approach For Acetabular Fractures: An Anatomic Study

Abstract

Before clinical applications, performing cadaver dissection is important to minimize intraoperative complications. This study was the first anatomic study in the literature that reveals the structures that are at risk during surgical treatment of acetabular fractures, which was treated with the modified medial Stoppa approach.

Anterior intra-pelvic approach and corona mortis vascular anastomoses: A clinical anatomical study shows high frequency

“…Rusu, Cergan et al 16 noticed the differences and systematically recorded the possibilities of CMVA, thereby determining in a study of 40 hemi pelvis dissections from 20 cadavers, 32 (80%) CMVA, of which 10 (31%) were arterial, 16 (53%) arterial and venous and 6 (18%) venous.In the dissection of 10 hemi pelvic cadavers, Kacra, Arazi et al 10 determined 4 (40%) venous CMVA. In the dissection of 20 hemi pelvis of 10 cadavers by Stavropoulou-Deli and Anagnostopoulou 23 .…”

“…The extended iliofemoral approach is recommended for complex fractures, but this approach also has high rates of complications and morbidity 2,6 . In the last few decades, the anterior intra-pelvic (AIP) approach has become known as a relatively less invasive approach for complex fractures, especially those involving the load-bearing roof and medial wall [7][8][9][10][11] . There has continued to be increasing popularity of the technique due to highly encouraging studies 5,7,9,11 .…”

“…In the AIP and ilioinguinal approaches, vascular anastomoses which provide the connection between the external and internal iliac vascular system on the posterior side of the superior pubic ramus, may be the cause of significant bleeding. Obturator vessels and nerves are the most important structures requiring attention because of their direct contact with the quadrilateral surface 10 . These vessels, which are known as the corona mortis vascular anastomoses (CMVA), must be located during surgical exposure and appropriately tied or cauterized.…”

Orthopedic Implications of the Corona Mortis: A Case Report

“…Traditional, modified Stoppa, ilioinguinal and iliofemoral approaches are often used to treat acetabular and pelvic ring fractures, with a fairly good success rate (70-95 %) and low rates of complications (Karunakar et al, 2004;Balbachevsky et al, 2006;Kacra et al, 2011;Bible et al;Court-Brown et al, 2014;Jensen et al, 2015). Despite that, some studies showed vascular injury rates of 6.2 % of patients with CM (Jensen et al).…”

Digital anatomical study and clinical application of screw placement for quadrilateral plate fractures in the danger zone

“…Unfortunately, screw placement for acetabular fracture is difficult duo to its complicated geometry, especially when conducted in the danger zone of the acetabulum for the treatment of displaced quadrilateral plate fractures. Traumatic hip arthritis can be developed in patients with non-anatomically reduced fractures even with well-placed screws [2].…”