Treatment results for acetabulum fractures using the modified Stoppa approach

Abstract

ObjectivesThe aim of this study was to evaluate the clinical and radiological results of the surgical treatment of acetabular fractures using modified Stoppa approach.MethodsA total of 57 patients (mean age 37.8 years; range 15–84) who underwent surgical treatment for acetabular fracture with modified Stoppa approach from February 2013 to June 2016 were included into the study. The mean follow-up time was 28.1 months (range 24–35). The records were reviewed for fracture patterns, time to surgery, operative time, blood loss, reduction quality, and perioperative complications. Reduction quality was graded as anatomic, imperfect, or poor. The Harris Hip Score (HHS) and Merle d'Aubigné score were used for functional evaluation.ResultsAmong the 63 acetabulum fractures of the 57 patients, 27 were associated with both columns, 12 were T-type fractures, 10 were transverse, 7 were anterior column/posterior hemitransverse, 5 were anterior column, and 2 were anterior wall fracture. A single surgeon performed all operations. Pfannenstiel incision was used in the first 19 cases while vertical midline incision in the remaining 38 cases. Average time to operation was 5.5 days, and supplemental lateral windows were used in 17 (29.8%) patients. Average blood loss and operation times were 660 mL and 152 min, respectively. Radiological outcomes were anatomic, imperfect, and poor in 52 (82.5%), 9 (14.2%), and 2 (3.2%) of the acetabulum fractures, respectively. Clinical outcomes at 2 years with HHS and Merle d’Aubigné scores were mean 86.6 (range 66–96) (Excellent in 27, good in 23, fair in 4, poor in 3 patient) and 16.7 (range 10–18) (Excellent in 25, very good in 18, good in 6, fair in 5, poor in 3 patient), respectively. There was a significant relation between the reduction quality and clinical outcome (p < 0.001), while there was no significant relation between the clinical outcome and the fracture type (p > 0.05). Iatrogenic external iliac vein damage was noted in 2 patients. Obturator nerve palsy was noted in 3 patients, who recovered spontaneously at mean time of 3.7 months (range 3–5). Rectus abdominus paralysis was noted in 2 of the 19 (10.5%) Pfannenstiel-incision patients but not in the vertical-incision patients.ConclusionOur experience in 57 patients shows that satisfactory results can be obtained, even in bilateral fractures with vertical midline incision.Level of evidenceLevel IV Therapeutic Study

Single Ilioinguinal Approach to Treat Complex Acetabular Fractures with Quadrilateral Plate Involvement: Outcomes Using a Novel Dynamic Anterior Plate–Screw System

“…In recent fifteen years, some scholars have used an infrapectineal plate to fix the quadrilateral plate through the modified Stoppa approach. Although it can solve some problems, such as comminuted fractures and osteoporosis, the fixation range is limited and an additional incision is often needed for complex fractures such as anterior column fractures.…”

Clinico-Radiological Evaluation of Modified Stoppa Approach in Treatment of Acetabulum Fractures

“…Also in the study by Kilinc et al in July 2018 conducted on 57 patients by Modified Stoppa approach on acetabular fracture which shows external iliac vein injury in two patients (3.5%), deep infection in two patients (3.5%), obturator nerve injury in three patients and DVT in four patients (7%). Deep infection was reported by Sagi et al in 1.8%, Anderson et al in 5.9%, Cole et al in 1.8%, Hirvensalo et al in five patients (3%), and Kiline et al in two patients (3.5%) [ 11 , 13 - 15 , 25 ]. It was treated with debridement with irrigation and antibiotic therapy but this results in fixation failure and poor prognostic factors.…”

“…In our study, out of the 30 patients, one patient has developed an external iliac vein injury which was repair by a vascular surgeon, one patient (3.33%) has the superficial infection for which debridement, regular dressing, and intravenous antibiotics were given, and resolve in one month, one patient (3.33%) developed obturator nerve injury and resolved in five to six months, one patient (3.33%) developed lateral femoral cutaneous nerve injury which was resolved within three months, and one patient (3.33%) developed urinary bladder injury intraoperatively which was 3.33% that was repaired by a general surgeon. [11,[13][14][15]25]. It was treated with debridement with irrigation and antibiotic therapy but this results in fixation failure and poor prognostic factors.…”

Complications of Acute Acetabular Fractures Surgical Treatment: Systematic Review

“…Количество и характер интраоперационных осложнений напрямую зависит от используемых доступов и от их количества [28,29,30]. Специалисты, применяющие два доступа, априори получают больше интра-и послеоперационных осложнений [4,22,25,27,31,32].…”