Surgical Treatment of Displaced Acetabular Fractures Using a Modified Stoppa Approach

Abstract

A retrospective evaluation was performed of 36 patients (25 males and 11 females; average age, 44 years) with displaced acetabular fractures who were treated with a modified Stoppa approach. Fractures included 18 anterior columns, 2 both columns, 8 anterior columns with posterior hemitransverse, 6 transverse, and 2 T-type, according to the Judet and Letournel classification. Range of motion, Harris Hip Scores, and Merle d'Aubigné scores were evaluated. Pre- and postoperative measurements taken included displacements and gaps on axial, coronal, and sagittal computed tomography (CT) images and postreduction quality assessed radiologically. Mean follow-up was 14.7 months. Mean perioperative bleeding was 970 cc (range, 800-1250 cc). Mean Harris Hip Score was 77.9, mean Merle d'Aubigné score was 16.4, mean flexion was 105.2°, and mean extension was 16.9°. Anatomical reduction of the acetabular fracture was achieved in 29 (80.5%) patients; it was satisfactory in 5 (13.8%) and poor in 2 (5%). Mean preoperative displacements on axial, coronal, and sagittal sections were 4.1, 3.6, and 3.1 mm, respectively, and mean postoperative displacements were 0.2, 0.3, and 0.2 mm, respectively. Mean preoperative gap distance was 14.5 mm, and mean postoperative gap distance was 1.1 mm. Postoperative foot drop was observed in 2 patients, obturator nerve damage in 1, partial iliac vein damage in 1, and avascular necrosis of the femoral head in 1. Despite a steep learning curve, the modified Stoppa approach is a good alternative to the ilioinguinal approach. It can be used to treat many complex acetabular fractures.

Modified Stoppa as an alternative surgical approach for fixation of anterior fracture acetabulum: a randomized control clinical trial

“…In the patient group of our study, the number of male patients was higher than female patients. Similar to our study, 16 studies on 609 patients to evaluate the Stoppa approach revealed that the male-female ratio was available for 566 patients, which was same as our study [5,[11][12][13][14][15][16][17][18][19][20][21][22][23]. Data for the remaining patients were unavailable due to various reasons.…”

“…The range of age in the 11 studies we cited was 10-88 years [5,[11][12][13][14][15] [11,[16][17][18][19][20]. The mean age in our study was much lower (36.8 ± 8.42 (range 20-73) years) compared to these observations.…”

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

“…The modi ed Stoppa approach with the lateral window of the classic ilioinguinal approach is practically convenient to access fracture fragments of posterior column effectively with advantages of less blood loss, shorter operation time, and fewer complications than other traditional approaches. 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].…”

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

“…Additionally, the afore-mentioned combined anterior approach is practically convenient to access fracture fragments of posterior column effectively with advantages of less blood loss, shorter operation time, and fewer complications than traditional approaches. The average intraoperative blood loss of our cohorts was 320 mL, which was significantly less than blood loss with a single ilioinguinal approach ranging from 760 mL to 1170 [24][25][26] or simultaneous anterior (modified ilioinguinal/Stoppa approach) and Kocher-Langenbeck approach ranging from 586 ml to 1252 ml [26][27][28][29][30]. The average operative time was 2.1 hours in our cohorts, compared with 2.6-4.3 hours for a single ilioinguinal approach [24,25] and 2.1-4.4 hours for the simultaneous anterior (modified ilioinguinal/Stoppa approach) and Kocher-Langenbeck approach [27-29, 31, 32].…”