Modified Stoppa Approach for Acetabular Fractures With Anterior and Posterior Column Displacement: Quantification of Radiographic Reduction and Analysis of Interobserver Variability

Andersen, Romney C.; O’Toole, Robert V.; Nascone, Jason W.; Sciadini, Marcus F.; Frisch, H; Turen, Clifford H.

doi:10.1097/bot.0b013e3181b2b4ca

Cited by 103 publications

(136 citation statements)

References 20 publications

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“…These structures were enclosed in their fasciae and retracted as a group in this approach. Of 29 patients, no acute vascular injuries were noted and no deep venous thrombosis was encountered, which is comparable to the study of Andersen et al [21]. Two cases had mild symptoms of the lateral femoral cutaneous nerve and improved within three months.…”

Section: Discussionsupporting

confidence: 74%

Newly modified Stoppa approach for acetabular fractures

Liu

Yang

et al. 2013

International Orthopaedics (SICOT)

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Purpose We present our experience of using a newly modified Stoppa approach combined with a lateral approach to the iliac crest in patients with acetabular fractures in reference to fracture reduction and fixation, technical aspects, and the incidence of complications. Methods We used a consecutive group of 29 adult patients with acetabular fractures treated operatively with a newly modified Stoppa approach between 2009 and 2011. The newly modified Stoppa approach was performed to fix the acetabular fractures with main anterior displacement and the anterior and lateral parts of the pelvis. This approach was combined with a lateral approach on the iliac crest for fractures of the iliac wing. Results All the patients were followed up for at least 1.5 years. Of the 29 patients, ten anterior column, two associated both column, seven anterior column with posterior hemi-transverse, four transverse, and six T-type fractures. The average blood loss was 950 mL, and average operative time was 155 minutes. Anatomic or satisfactory reduction was achieved in 96 % of the acetabular fractures. Two patients had mild symptoms of the lateral femoral cutaneous nerve and improved within three months. Conclusions The newly modified Stoppa approach provides excellent visualization to the anterior column, quadrilateral surface and permits good postoperative results for treatment of acetabular fractures. We considered this technique as a viable alternative for the ilioinguinal approach when exposure of the anterior acetabulum is needed.

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Section: Discussionsupporting

confidence: 74%

Newly modified Stoppa approach for acetabular fractures

Liu

Yang

et al. 2013

International Orthopaedics (SICOT)

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“…Although the article did not meet our inclusion criteria because of lack of documentation of time from injury to surgery, Andersen et al 76 describe a method of measuring femoral head and quadrilateral plate medialization. On the anteroposterior view of the pelvis, a line is drawn from the spinous process of the L5 vertebral body to the center of the symphysis pubis.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Measurement of Displacement in Acetabular Fractures: A Systematic Review of the Literature

Dodd

Osterhoff

Guy

et al. 2016

Journal of Orthopaedic Trauma

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OBJECTIVES: To report methods of measurement of radiographic displacement and radiographic outcomes in acetabular fractures described in the literature. METHODS: A systematic review of the English literature was performed using EMBASE and Medline in August 2014. Inclusion criteria were studies of operatively treated acetabular fractures in adults with acute (<6 weeks) open reduction and internal fixation that reported radiographic outcomes. Exclusion criteria included case series with <10 patients, fractures managed >6 weeks from injury, acute total hip arthroplasty, periprosthetic fractures, time frame of radiographic outcomes not stated, missing radiographic outcome data, and non-English language articles. Basic information collected included journal, author, year published, number of fractures, and fracture types. Specific data collected included radiographic outcome data, method of measuring radiographic displacement, and methods of interpreting or categorizing radiographic outcomes. DATA SYNTHESIS: The number of reproducible radiographic measurement techniques (2/64) and previously described radiographic interpretation methods (4) were recorded. One radiographic reduction grading criterion (Matta) was used nearly universally in articles that used previously described criteria. Overall, 70% of articles using this criteria documented anatomic reductions. CONCLUSIONS: The current standard of measuring radiographic displacement in publications dealing with acetabulum fractures almost universally lacks basic description, making further scientific rigor, such as testing reproducibility, impossible. Further work is necessary to standardize radiographic measurement techniques, test their reproducibility, and qualify their validity or determine which measurements are important to clinical outcomes. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…The clinical feasibility and safety of limited approaches in osteosynthesis of acetabular and pelvic fractures has been shown previously [8,25,26]. Percutaneous fracture reduction can be achieved employing Schanz screws as joysticks for fragment manipulation [26].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous fracture reduction can be achieved employing Schanz screws as joysticks for fragment manipulation [26]. Furthermore, a limited Stoppa approach potentially combined with the first window of a classical ilioinguinal approach is qualified for minimally invasive AFO [8]. In orthopaedic and trauma surgery, the importance of preoperative planning is steadily increasing.…”

Section: Discussionmentioning

confidence: 99%

“…Since anatomical implants (AIs) solve the issue of implant fit, they enable minimally invasive osteosynthesis when fracture reduction can be accomplished by closed or less invasive means [7]. In the case of AFO, AIs could be inserted through selected anatomical windows of a limited ilioinguinal approach, a modified Stoppa approach, or an intra-pelvic approach [8][9][10]. Thus, minimally invasive osteosynthesis (MIO) could significantly reduce operative morbidity and also lower the rate of intra-and postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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Morphometric analysis of anatomical implant forms for minimally invasive acetabular fracture osteosynthesis

Maier

Kamer

Noser

et al. 2012

Computer Aided Surgery

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Introduction: Anatomical implants enable minimally invasive osteosynthesis (MIO) and represent ideal complements of computer-assisted surgical workflows. This 3D morphometric study analyzes anatomical implant forms (AIF) for acetabular fracture osteosynthesis (AFO). Materials and Methods: Three-dimensional pelvis models were created from clinical CT data of 99 European-Caucasian patients (50 females, 49 males). The mean age of the patients was 60.1 years (range: 20-89; SD 10.8). Definition of a referential region of interest (ROI) corresponding to an AIF for AFO was followed by automated ROI computation for each of the 198 hemipelvises. Three-dimensional statistical modeling and analysis of the resulting 198 homologous ROIs consisted of thin-plate spline transformation, generalized Procrustes fit, and principal component analysis. Results: The mean ROI length was 18.2 cm (range: 16.1-20.1 cm; SD 0.76). The first principal component (PC1) mainly modeled the ROI length, which correlated well with body height (r ¼ 0.325; p < 0.001). PC1 comprised 47.4% of the overall ROI form variation. PC2 primarily influenced the ROI curvature in the anterior-posterior (inlet) view. Curvatures were more pronounced in female patients compared to males (p < 0.001). There was no gender-specific ROI size variation. PC1-4 contained 80.2% of the total ROI form variation. Left and right ROI forms displayed symmetry. Conclusion: This 3D morphometric study demonstrates the feasibility of anatomical implants for minimally invasive acetabular fracture osteosynthesis. Implant size/length is by far the most important variable of form variation. The necessity of gender-specific implant forms requires further investigation. The non-fractured, contralateral hemipelvis can be used for preoperative surgical planning. Ultimately, the plate design will depend on prospective implant fit tests based on the required fit as defined by the clinician.

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Modified Stoppa Approach for Acetabular Fractures With Anterior and Posterior Column Displacement: Quantification of Radiographic Reduction and Analysis of Interobserver Variability

Cited by 103 publications

References 20 publications

Newly modified Stoppa approach for acetabular fractures

Newly modified Stoppa approach for acetabular fractures

Radiographic Measurement of Displacement in Acetabular Fractures: A Systematic Review of the Literature

Morphometric analysis of anatomical implant forms for minimally invasive acetabular fracture osteosynthesis

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