Vertical versus Pfannenstiel incision modified Stoppa approach in the treatment of acetabular fractures

Abstract

OBJECTIVES: To compare the patient and fracture characteristics, radiological, functional, and quality of life outcomes, the need for a lateral window approach and requirement of total hip arthroplasty (THA), and complications in patients with simple and complex acetabular fractures who underwent a modified Stoppa approach through vertical and Pfannenstiel incisions. METHODS: Design: Retrospective comparison study Setting: Level one trauma center Patient Selection Criteria: Patients with acetabular fractures (OTA/AO type 62A-B-C) treated with vertical (Group V) or Pfannenstiel (Group P) incision modified Stoppa approach between 2010 and 2020. Outcome Measures and Comparisons: Patient characteristics, radiological evaluations (reduction quality and posttraumatic osteoarthritis), patient functional outcomes (SF-12 PCS, SF-12 MCS, HHS, and Merle d'Aubigne Apostel), approach modifications and stratification by fracture type and complications were compared between those treated with vertical or Pfannenstiel incisions. RESULTS: 104 patients (mean age of 38.5 ±14.3 year) were included. There was no significant difference between the Pfannenstiel or vertical groups regarding patient and fracture characteristics (p = 0.137), postoperative reduction quality (p = 0.130), or the mean functional and quality of life outcome scores at the last follow-up (p = 0.483 for HHS, p = 0.717 for Merle d'Aubigne Apostel score, p = 0.682 for SF-12 PCS, and p = 0.781 for SF-12 MCS). In group P, significantly more patients needed additional lateral incisions (40.8% vs. 10.9%; p 0.001) and total hip replacement procedures (12.2% vs. 1.8%; p = 0.049). The total, early, and late complication rates were significantly higher in group P (p 0.001, p = 0.034, and p = 0.049, respectively). CONCLUSION: Pfannenstiel incision was associated with higher complication rates than vertical incision in acetabular fractures treated through a modified Stoppa approach. Fracture complexity is associated with the need for a lateral window approach and THA, as well as a worse functional and radiological outcome regardless of incision type. However, it was not associated with the development of intraoperative or postoperative complications.