Modified Stoppa Approach for Surgical Treatment of Acetabular Fracture

Abstract

BackgroundWe analyzed the extent of the comminution in the acetabular weight-bearing area, the clinical and radiographic results, and the complications after a minimum 2-year follow-up of the modified Stoppa approach for the treatment of acetabular fractures, and we attempted to evaluate the efficacy of the operative technique.MethodsAll of the 22 patients, who needed the anterior approach for the treatment of acetabular fractures at our hospital from November 2007 to November 2010, were subjected to surgery via the modified Stoppa approach. Fracture pattern, operative time, blood loss during the operation, quality of reduction, number of bony fragments in the acetabular weight-bearing area, and postoperative complications were assessed by retrospectively analyzing the medical records and the radiographic examinations. The results after the operation were analyzed based on the criteria of Matta.ResultsThe clinical results were excellent in 3 cases, good in 13 cases, and poor in 4 cases, while the radiographic results were excellent in 5 cases, good in 13 cases, and poor in 2 cases. Although the quality of reduction and the clinical results according to the extent of comminution were statistically significant (p = 0.03 and p = 0.04, respectively), the radiographic results were not statistically significant (p = 0.74).ConclusionsIt can be concluded that the modified Stoppa approach could be used as an alternative to the classic ilioinguinal approach. In addition, comminution of the acetabular fracture was an important factor causing non-anatomic reduction and finally unsatisfactory clinical results.

Mid-term Results of an Anterior Plating Via Combined Anterior Approach for complex Acetabular Fractures: A Retrospective Cohort Study

“…Similarly, 85% of our cases achieved good or excellent hip function at average 17-month postoperatively, consistent with a prior investigation reporting satisfactory hip function in 85.2% cases treated via simultaneous ilioinguinal and Kocher-Langenbeck approaches over 4-year postoperatively [42]. [34]. For patients with obesity or history of previous low abdominal surgeries with possible local adhesions, other approaches might be favorable.…”

Optimizing the Anatomic Reduction of Complex Acetabular Fractures: A Technical Enhancement to the Modified Stoppa Approach

“…As shown by other authors, [18][19][20] there exists a close relationship between radiologic and clinical results. Presence of the gull sign, described by Anglen, et al, [21] is indicative of acetabular dome impaction and is often associated to a poor prognosis.…”

“…Lafflame, et al [22] correlated comminution of the dome with a less effective reduction and with progression to total hip arthroplasty. In their study, Kim, et al [18] reported lower reduction rates, and hence poorer functional results, when 3-or-more-part fractures were present in the dome area (p = 0.03). For that reason, reconstruction of the acetabular weight bearing area is a prerequisite for satisfactory clinical results.…”

Mid-term results of an anterior plating via combined anterior approach for complex acetabular fractures: a retrospective cohort study

“…The average intraoperative blood loss in our cohorts was 320 mL, which was signi cantly less than blood loss with a single ilioinguinal approach ranging from 760 mL to 1170 [26,29] or simultaneous anterior (Stoppa/iliac window approach) and Kocher-Langenbeck approach ranging from 586 ml to 1252 ml [30][31][32]. Similarly, the average operative time in our cohorts (2.1 hours) is considerably shorter than the single ilioinguinal approach (2.6-4.3 hours) [26,33] and the simultaneous anterior modi ed ilioinguinal/Stoppa approach (2.1-4.4 hours) [30,31,[34][35][36]. Moreover, no heterotopic ossi cation and only two obturator nerve injury (recovered within 3 months postop) was observed in our cohorts, which are also signi cantly less than the rates of heterotopic ossi cation (25.6%), traumatic nerve palsy (16.4%), and iatrogenic nerve palsy (8.0%) in 3670 patients reported by a recent meta-analysis [37].…”