FIXATION OF ACETABULAR (ANTERIOR RIM, QUADRILATERAL PLATE) FRACTURES WITH MODIFIED STOPAA APPROACH “OPTIMUM APPROACH”

Abstract

Introduction: Pelvis is important bony structure of body that provide main weight bearing surface for the hip joint in form of acetabulum, with the advancement of the high speed transportations, pelvic trauma has been raised in numbers so as acetabular fractures. Stable acetabular fractures fixation with accurate anatomic reduction always has been a big challenge for orthopaedic surgeons. Acetabular fractures fixation has risen step ahead after evolution of modified stoppa approach, as this approach allow minimum soft tissue handling, easy accessibility and provide adequate exposure to intrapelvic structures. Recently modified stoppa approach has evolved as primary approach for acetabular fractures fixation. AIM: To perform acetabulum fracture fixation through an optimum surgical exposure “modified stoppa approach” Materials And Method: this study conducted on 20 patients who presented with acetabular fractures after an RTA or fall from height or due to other various cause. Fracture fixation done through modified stoppa approach for those who met in our inclusion criteria ,to provide pelvic and hip joint stability. Patients demographics, location, duration from injury to surgical interventions, duration of hospital stay, if any complication occurred during surgery were recorded. Result: Out of total 20 patients 17 were male and 3 patients were female, average age 39year[Range from 18 to 60 yr], 12 patients having isolated unilateral acetabulum fracture present, 2 having bilateral acetabular fracture and 4 having associated pelvic bone fracture along with unilateral acetabulum fracture, 2 patients having long bone of lower limb fracture along with acetabular injury. All the fixation done through modified stoppa approach. Intraoperatively in all the patients easy accessibility and wide exposure obtain for intrapelvic structures. All the neurovascular structures easily identified and protected over the surgical site. Intraoperatively no clinical and radiological complication were observed in all patients. Post operatively all the patients were able to bear weight, within the 12±4 week,. Conclusion: We got a conclusion that the modified stoppa approach is anterior intrapelvic approach which provides an excellent view to the acetabular[anterior column, quadrilateral plate, posterior hemitransverse] and other intrapelvic structures, with minimal soft tissue handling, easy accessibility to preserve neurovascular structures. This approach provides direct access to the pubis, the posterior surface of the ramus, the quadrilateral surface, the pubic eminence, and the infrapectineal surface, as well as the sciatic buttress, sciatic notch, and the anterior sacroiliac joint. It can be used in most of the acetabular fractures fixation, the only downside is being the steep learning curve and familiarity of the structures while addressing these fractures. Keywords: Acetabulum, Acetabular fracture, Modified stoppa approach, quadrilateral plate.