Abstract
BackgroundThe aim of our study was to evaluate the efficacy of Modified Stoppa approach for surgical treatment of acetabulum fractures by analyzing clinical and radiological outcomes. Also, we assess intraoperative and postoperative complications of fracture treated by using Modified Stoppa approach.ObjectivesTo evaluate clinical outcomes of Modified Stoppa approach by using Merle d'Aubigne hip score. To evaluate the radiological reduction quality of Modified Stoppa approach by using the criteria of Matta, and to assess complications of Modified Stoppa approach. MethodThirty-two patients participated in this study (mean age 40 years; range 18-60 years) and the male to female ratio was 4:1, patients who underwent surgical intervention for acetabular fracture by using Modified Stoppa approach from Oct 2017 to April 2019 were included. Out of 32 patients, two were lost in follow up, leaving 30 of 32 patients for clinico-radiological analysis. We classified the fracture pattern according to Judet and Letournel classification based on preoperative X-ray AP view, Judet View, and 3D-CT pelvis. Operative time, blood loss, reduction quality, and perioperative complications were assessed in each patient. Clinical outcomes were assessed by Merle d’Aubigne hip score and radiological outcomes by criteria of Matta. ResultsOut of 30 acetabulum fractures in 30 patients, three (10%) were categorized as anterior column fracture, one (3.3%) as transverse with posterior wall, one (3.33%) as T-type, six (20%) as anterior column with posterior hemi-transverse and 19 (63.33%) as both column fractures. In our study, most patients have trauma due to road traffic accident (RTA) in 25 (83.3%) and fall from stairs in three (10%) patients. Timing of surgery after trauma was average 5.83 days (range three to 15 days), Mean surgical time determined to be 214.66 min (range 150-350 min) and mean intraoperative loss 683.33 ml (range 230-1250 ml). Clinical outcomes by Merle d’Aubigne hip score was excellent in 13 (43.33%), good in 15 (50%), fair in two (6.66%) patients whereas poor results in 0 (0%) patient (p=0.001). Quality of reduction by Matta criteria was found to be an anatomical reduction in 26 (86.6%), imperfect reduction in three (10%), and poor reduction in one patient (3.33%) (p<0.001). Radiological grading by Matta criteria was excellent in 24 (80%), good in five (16.66%), and fair in one (3.33%) patient, and no patients met criteria for poor results (p<0.001). In operative complications one patient developed an external iliac vein injury which was repaired by a vascular surgeon, one patient had a superficial infection for which debridement, regular dressing, and IV antibiotics given and resolve in one month, obturator nerve injury in one patient which was resolve in five to six months, lateral femoral cutaneous nerve injury in one patient which resolved within three months and one patient urinary bladder injury which was repaired by a general surgeon. ConclusionOur experience with Modified Stoppa approach for surgical treatment of acetabulum fracture in 30 patients is excellent and effective for better visualization to anterior column, quadrilateral plate, and up to sacroiliac joint. This approach provides better visibility of the fracture site which allows for good to an excellent reduction of fracture and fixation. Although Stoppa approach is cosmetic surgery in terms of scar size, there is less complication rate than the ilioinguinal approach.
Highlights
The acetabulum is the most important weight-bearing joint, the hip joint, and the fracture of the acetabulum is an intra-articular fracture, and to obtain the most favorable results, accurate anatomic reduction, firm fixation, and early rehabilitation are mandatory [1,2,3]
In operative complications one patient developed an external iliac vein injury which was repaired by a vascular surgeon, one patient had a superficial infection for which debridement, regular dressing, and IV antibiotics given and resolve in one month, obturator nerve injury in one patient which was resolve in five to six months, lateral femoral cutaneous nerve injury in one patient which resolved within three months and one patient urinary bladder injury which was repaired by a general surgeon
Jakob et al and recently, Anderson et al Illustrate a modified approach using the Stoppa and iliac surgical window for the treatment of acetabular and pelvic ring fractures [12,13]. This approach became popular over the past decade for anterior column fractures and is satisfactory for the majority of cases while providing excellent visualization of and good entrance to the quadrilateral plate and parts of the posterior column [11]. We present this Modified Stoppa approach with a lateral iliac window, enroll the suprapubic and lateral windows that are partially utilized in the ilioinguinal approach
Summary
The acetabulum is the most important weight-bearing joint, the hip joint, and the fracture of the acetabulum is an intra-articular fracture, and to obtain the most favorable results, accurate anatomic reduction, firm fixation, and early rehabilitation are mandatory [1,2,3]. The treatment of acetabular fractures is quite difficult due to the associated major organ injuries and due to the complicated fracture type and difficulties in the operative approach for reduction. Since the initial work of Letournel, the operative treatment of acetabular fractures has become the gold standard for displaced and unstable fracture patterns [4]. The choice of surgical approach depends on the fracture pattern, direction of displacement, skin condition at the surgical incision site, and duration since the time of injury. The pattern of fractures involving medial displacement especially the acetabular quadrilateral plate is technically strenuous, because of the location of the fracture in the true pelvis, the scanty bone stock, and the fracture’s proximity to the articular surface of the hip joint [5]. We assess intraoperative and postoperative complications of fracture treated by using Modified Stoppa approach
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