Modified Stoppa approach in treatment of pelvic and acetabular fractures

Abstract

Objective To evaluate the modified Stoppa approach in treatment of patients with pelvic and acetabular fractures. Methods We analyzed the outcomes of 26 consecutive patients with fractures of the pelvic ring and 9 patients with acetabular fractures who had been treated between March 2008 and December 2009 by open reduction and internal fixation through the modified Stoppa approach. The modified Stoppa approach was made through a low midline incision to fix the pelvis and acetabular fractures. By Tile classification, the 26 pelvic fractures included 2 cases of B1, 4 of B2, 7 of B3, 4 of C1-1, 2 of C1-2, 4 of C1-3, and 3 of C2. By Letournel classification, the 9 acetabular fractures included one case of anterior column, 3 transverse cases, 2 T type cases, one anterior column plus posterior transverse case, and 2 cases of both columns. For pelvic fractures, the modified Stoppa approach was used exclusively in 10 cases, in combination with the iliac fossa approach in 15 cases, and in combination with the posterior approach in one case. For acetabular fractures, the modified Stoppa approach was used exclusively in 3 cases, in combination with the Kocher-Langenbeck approach in 4 cases, and in combination with the Kocher-Langenbeck and iliac fossa approaches in 2 cases of both columns. Results The average operation time was 90 min (65 to 135 min)and the blood loss averaged 320 mL(150 to 1200 mL) in all but one patient with obsolete fracture of both columns. The reductions of the pelvic and acetabular fractures were all excellent and good. Twenty-two patients with pelvic fracture were accessible for an average follow-up of 4 months. Among them, one case of plate breakage and one case of screw loosening were found. Seven patients with acetabular fracture were accessible for an average follow-up of 4 months. One case of mild hip flexion and one case of ectopic ossification were found in them but there was no femoral head necrosis. Satisfactory functional results were achieved in the 29 cases that had been followed up. Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat pelvic and acetabular fractures effectively, providing advantages of easy manipulation and a low complication rate. Key words: Pelvis; Acetabulum; Fracture; Surgical approach