Techniques for Reduction of the Quadrilateral Surface and Dome Impaction When Using the Anterior Intrapelvic (Modified Stoppa) Approach

Abstract

As the anterior intrapelvic approach (AIP or modified Stoppa) has become more popular, its utility has evolved to address specific problems that are not well addressed by the ilioinguinal approach. These include anterior column (AC) fractures associated with medialization of the femoral head (protrusio) and impaction of the superomedial acetabular dome. If left unaddressed, these problems may lead to poor clinical outcomes. The AIP approach, in contrast to the ilioinguinal approach, takes a more direct path to the medial elements of the AC in the true pelvis. This exposure allows access to the impacted dome segment through the displaced AC fracture and wide visualization of the quadrilateral surface, which in turn allows direct reduction and optimal implant placement to neutralize the fracture's deforming forces. The purpose of this article is to discuss the reduction of dome impaction and the quadrilateral surface using the AIP approach.