Stoppa Approach Research Articles

Periacetabular osteotomy: A novel application of modified Stoppa approach.

Background: The Bernese periacetabular osteotomy (PAO) is a well-established procedure for symptomatic hip dysplasia in adolescents and young adults. However, it remains a technically demanding procedure, and several major complications have been described, many of which are related to the approach and surgical exposure. The current study evaluates the efficacy and safety of PAO performed through a modified Stoppa approach. Methods: A prospective series of nine consecutive patients with hip dysplasia were treated PAO through the modified Stoppa approach. The mean age was 22.4 years (15–30 years) and the mean follow-up was 3.2 years (2–5 years). Harris hip score (HHS) was used as a functional score, and the radiographic indices included the lateral center-edge angle (LCEA) and Tönnis roof angle. Results: The approach allowed the osteotomy lines to be performed under direct visualization from the intra-pelvic surface of the acetabulum, aided by fluoroscopy. A lateral window was added to perform the final iliac cut and for subsequent mobilization and fixation of the acetabular fragment. The mean HHS improved significantly from 70.8 ± 4.9 points to 90.1 ± 3.3 points (p < 0.001). The mean LCEA improved from 8.2° ± 4.9 (range: 0–14) to 32.7° ± 5.3 (range: 26–40), with a mean improvement of 24.5°. The mean Tönnis angle improved from 28.4° ± 4.4 (range: 22–35) to 3.8° ± 3.3 (range: 0–10). Two patients had irritation from prominent screw heads that necessitated removal 1 year after the index procedure. One patient had radiographic progression of osteoarthritis. No cases of infection, non-union, heterotopic ossification, or nerve palsy were identified till the latest follow-up. Conclusion: Ganz PAO can be safely conducted through the modified Stoppa approach, providing direct exposure to the osteotomized surfaces, and protecting susceptible neuro-vascular structures.Level of evidence: IV.

Adhesion of External Iliac Vessels Found in a Modified Stoppa Approach to Acetabular Fracture in a Patient with a History of Previous Abdominal Surgery

Adhesion of External Iliac Vessels Found in a Modified Stoppa Approach to Acetabular Fracture in a Patient with a History of Previous Abdominal Surgery

Outcome of Modified Stoppa Approach for Fixation of Acetabular Fractures

Objective: The purpose of this study is to determine the functional and radiological outcomes of modified stoppa approach for fixation of acetabular fractures. Study Design: Descriptive Study Place and Duration: Study was conducted at Orthopaedic department of Ayub Teaching Hospital Abbottabad, Fauji Foundation Hospital, Rawalpindi and Islamabad International Hospital E-11/4, Islamabad for duration of two years form July 2019 to June 2021. Methods: There were thirty patients of both genders who had acetabular fractures were presented. Included patients were aged between 18-55 years. Patients' age, sex, body mass index and cause of fractures were recorded after taking informed written consent. Types of acetabular fractures were also recorded. Modified stoppa approach was used to operate acetabular fractures. Outcomes were operative time, radiological and functional outcomes were assessed in terms of excellent, good, fair and poor results. Post-operative complications and patients' satisfaction was also calculated. We used SPSS 24.0 version to analyze complete data. Results: Among 30 cases, majority of the patients 20 (66.67%) were males and 10 (33.33%) were females with mean age 29.4±10.37 years. Mean body mass index of the presented patients was 23.7±7.25 kg/m2. RTA was the most common cause found in 17 (56.67%), followed by fall from height in 8 (26.67%) and 5 (16.67%) fractures had other causes. Anterior wall fracture was the most common type found in 14 (46.67%) cases. Mean operative time was 3.87±13.18 hours. As per radiological outcomes, frequency of anatomical reduction found in 21 (73.3%) cases, not perfect found in 5 (16.67%) cases and poor results found in 4 (13.3%) patients. Majority of the cases 18 (60%) had good results in functional outcomes, excellent results in 7 (23.3%), fairs results in 3 (10%) cases and poor in 2 (6.67%) cases. Post-operative complications found in 2 (6.67%) cases. Satisfaction rate among patients was 86.67%. Conclusion: We found in this study that the use of stoppa approach for fixation of acetabular fractures was effective and safe method in terms of good radiological and functional outcomes. Except this less operative time and less number of complications were calculated with high number of customer’s satisfaction. Keywords: Acetabular Fractures, MSA, Complications, RTA

Perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures: a single-institution review of 48 cases.

The current study aimed to report the perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures. We analyzed 48 consecutive operations in 45 patients who were treated with internal fixation using the modified Stoppa approach between March 2016 and July 2018. This included three revision operations. The mean age of the patients was 54.5 years, and the patients included 35 male patients and 10 female patients. All fractures occurred as a consequence of high-energy trauma and 70.3% had associated injuries at the time of the fracture. The mean Injury Severity Score was 9.03±5.60. The perioperative complications found during and immediately after surgery were recorded and were classified into three categories: vascular injuries, nerve injuries, and other complications. Overall, 14 perioperative complications (29.2%) in 14 cases were identified. The most common complications were nerve injuries, which occurred in seven cases, all involving the obturator nerve. Uncontrollable vascular injuries occurred in six cases, which required additional incisions and support of vascular surgeons or postoperative interventions. Additionally, one case of peritoneal tearing occurred, which required help from an abdominal surgeon. While the modified Stoppa approach seems to be a viable method to treat pelvic fractures, significant perioperative complications may occur, suggesting that surgeons should pay careful attention to minimize the damage to other structures and that appropriate support from other surgical departments is paramount.

The use of a 3D-printed personalised drill guide for posterior column lag screw fixation in displaced transverse acetabular fracture: A case report.

Introduction and importanceAnterior column plate combined with posterior column screws have been effectively used for treatment of displaced transverse acetabular fractures. This article presents the use of 3D-printed technology for customising a guide template to appropriately place posterior column screw.Case presentationA 50-year-old female suffered displaced juxtatectal fracture of the right acetabulum. A personalised guide for antegrade posterior column screw placement was designed based on the data of her pelvic CT-scan. This guide and a prototype of her right acetabulum - created by mirroring the intact left acetabulum - were 3D-printed for preoperative evaluation and pre-contouring of reconstruction plate. Modified Stoppa approach and additional lateral window were used for direct reduction, anterior column plate and posterior column lag screw fixation. Post-operative CT-scan showed good reduction and nearly ideal screw position.Clinical discussionAnterior column plate and antegrade posterior column screw could provide joint stability and early mobilisation for displaced transverse acetabular fractures. However, determination of optimal entry point, direction and length for screw insertion is still technically demanding. The 3-D reconstruction images of hemipelvic specimen allowed us to identify the safe bone corridor, design a drill guide to put the proper guide pin and conduct preoperative trial. All those resulted in appropriate real screw fixation with reduction of soft tissue damage, X-ray exposure and time of operation.ConclusionThe use of 3D-printed personalised guide for posterior column screw fixation is a promising alternative option for treatment of displaced transverse acetabular fracture where 3D-navigation system is not available.

Traitement des fractures de l’acetabulum atteignant la lame quadrilatère : comparaison des voies ilio-inguinales et de Stoppa

BackgroundAcetabular fractures with quadrilateral plate (QLP) involvement have traditionally been treated by buttress plates applied through an Ilio-inguinal approach. Recently, many surgeons prefer the application of infra-pectineal plates through the modified Stoppa approach for this purpose. Whether one method can be preferred over the other is a matter of investigation. HypothesisThe research question was whether an infra pectineal plate applied through the modified Stoppa approach for acetabular fractures with QLP involvement would result in an equivalent or better outcome than a buttress plate applied through an ilioinguinal approach. Patients and methodsThis was a retrospective study of patients with QLP fractures operated by either of the two methods and who had completed at least one year follow up. Demographic and surgical details and the radiological and clinical outcomes at the last follow-up visit were obtained from patient records. ResultsForty one patients were treated with a buttress plate applied through an ilioinguinal approach (group A), and 49 patients were treated with an infra-pectineal plate by the modified Stoppa approach (group B). Duration of surgery and intra-operative blood loss was significantly less in group B patients. Radiological and clinical outcomes were better in group B patients than group A patients. Implant loosening was more frequent in group A patients. Injury to the obturator vessels were more common in group B patients. ConclusionWith a comparatively lesser surgical duration and blood loss, better clinical and radiological outcomes at least one year after the surgery, an infra-pectineal plate applied through the modified Stoppa approach can be considered the preferred treatment for most acetabular fractures with QLP involvement. Level of evidenceIII.

Omega plate for the treatment of acetabular fractures involving the quadrilateral plate.

This retrospective study aimed to assess the outcome of a modified Stoppa approach using an anatomically precontoured plate for the treatment of acetabular fractures. In total, 30 patients (mean age 50.3 years; 25 men and 5 women) with acetabular fractures were treated between January 1, 2018 and December 31, 2019. In all 30 cases, fracture reduction was performed through a modified Stoppa approach and fixed with the omega plate. In specific fracture patterns, additional approaches were needed (lateral window in 4 cases and posterior Kocher-Langenbeck approach in 7 cases). Patients were assessed for restoration of the hip joint congruency, complications, and overall fracture reduction. Quality of reduction was categorized based on Matta's radiological principles and to assess functional outcome the Merle d'Aubigné-Postel and Harris hip score was used. The average anesthesia time was 253.6 min, the mean intraoperative blood lost was 266.6 ml and the mean intraoperative fluoroscopy dose was 3.21 mGy. According to Matta criteria for reduction quality, anatomical reduction was recorded in 22 cases, imperfect reduction in 6 cases and 2 cases had poor reduction. The average follow-up was 22.5 months. Malunion, loss of reduction or implant loosening were not recorded. Late complications included one case of avascular necrosis of the femoral head and post-traumatic arthritis changes in 5 cases. At the final follow-up, a mean Merle d'Aubigné-Postel score of 13.26±4.46 and a mean Harris score of 86.03±13.37 were recorded. The possibility of an anatomically precontoured plate with subsequent lower operative time combined with stable fixation of the primary acetabular fracture fragments and the quadrilateral plate makes the omega plate a viable option for treating acetabular fractures with a very low complication rate and good to excellent results in 89% of the cases.

Research progress of different surgical approaches in treatment of acetabular both-column fractures

To review the research progress of different surgical approaches in the treatment of acetabular both-column fractures. The domestic and foreign related research literature on surgical approaches for acetabular both-column fractures was extensively consulted. The anatomical characteristics, exposure ranges, advantages, disadvantages, and indications of various common surgical approaches for both-column fractures were mainly summarized. The ilioinguinal approach is more suitable for both-column fractures if the anterior column fracture is complicated or combined with the anterior wall fracture while the posterior column fracture is simple and stable. The modified Stoppa approach or the lateral (para) rectus abdominal approach is the preferred choice when both-column fractures are combined with a quadrilateral fracture or femoral head dislocation. What's more, the Kocher-Langenbeck approach is required when the posterior column fractures are complicated or combined with posterior wall fractures. In addition, the simultaneous ilioinguinal and Kocher-Langenbeck approaches are the first choices when the both-column fractures possessing extremely severe and obvious displacement. The reasonable choice of surgical approach is extremely important for acetabular both-column fractures. Each surgical approach has its advantages and limitations. It is necessary to take the precise reposition of the acetabular joint surface as the principle, and comprehensively judge the fracture types and severity of anterior column, posterior column, and square area, and then select the optimal surgical approach for surgical treatment.

Modified Stoppa Approach for the Treatment of Complex Acetabular Fractures.

Complex acetabular fractures are due to high-energy trauma in most cases. The operative management of these types of fractures is often difficult and technically challenging. Almost all of these types of fractures are treated through extensile approaches, and a variety of them have been described. Some of these approaches are associated with complications such as infection, heterotopic ossification, and increased blood loss in addition to increased operative time. This retrospective study was performed at an academic Level I trauma center. From January 2013 to March 2019, 21 patients with complex acetabular fractures were treated with open reduction and internal fixation through a single anterior modified Stoppa approach. The average operative time was 98.80 minutes (range, 60-180 minutes), the average follow-up time was 40 months (range, 24-72 months), and the average Harris Hip Score (HHS) was 87.85 (range, 75-100). At the latest follow-up, 12 (57.1%) patients had an excellent HHS, 8 (38.1%) patients had a good HHS, and 1 (4.8%) patient had a fair HHS. Complex acetabular fractures can be effectively managed by a modified Stoppa approach without the need for extensile or combined approaches. [Orthopedics. 2021;44(3):e353-e358.].

Treatment of acetabular fractures with quadrilateral plate injury – a comparison of two commonly used methods

BackgroundAcetabular fractures with quadrilateral plate (QLP) involvement have traditionally been treated by buttress plates applied through an Ilio-inguinal approach. Recently, many surgeons prefer the application of infra-pectineal plates through the modified Stoppa approach for this purpose. Whether one method can be preferred over the other is a matter of investigation. HypothesisThe research question was whether an infra pectineal plate applied through the modified Stoppa approach for acetabular fractures with QLP involvement would result in an equivalent or better outcome than a buttress plate applied through an ilioinguinal approach. Patients and MethodsThis was a retrospective study of patients with QLP fractures operated by either of the two methods and who had completed at least one year follow up. Demographic and surgical details and the radiological and clinical outcomes at the last follow-up visit were obtained from patient records. ResultsA total of 41 patients were treated with a buttress plate applied through an ilioinguinal approach (group A), and 49 patients were treated with an infra-pectineal plate by the modified Stoppa approach (group B). Duration of surgery and intra-operative blood loss was significantly less in group B patients. Radiological and clinical outcomes were better in group B patients than group A patients. Implant loosening was more frequent in group A patients. Injury to the obturator vessels were more common in group B patients. ConclusionWith a comparatively lesser surgical duration and blood loss, better clinical and radiological outcomes at least one year after the surgery, an infra-pectineal plate applied through the modified Stoppa approach can be considered the preferred treatment for most acetabular fractures with QLP involvement. Level of evidenceIII.

Intra-Pelvic Penetration of Broken Guide Wire during Fixation of Hip Fracture: Presentation of a Case and Review of Literature

Background: The application of a cannulated device is a widely used fixation method for hip fractures. Although the breakage of the guide wire during this procedure is an uncommon complication, migration of the broken fragment might be catastrophic. Case Report: We presented a case of intertrochanteric fracture with breakage of the lag screw guide wire in the acetabulum during fixation with cephalomedullary nail. The broken fragment was located with computed tomography (CT) scan and removed through Stoppa approach. Conclusion: We found the Stoppa approach a safe and useful method for extracting the intra-pelvic broken guide wire.

Treatment sequence of combined pelvic injury, consisted of upper pubic ramus fracture, sacroiliac joint dislocation with open book injury, using Stoppa approach

Among pelvic serious injuries is the so-called “open book” injury of the pelvis, with Sacroiliac Joint Disruption (SIJD) in combination with upper pubic ramus or anterior column fracture, contralateral or ipsilateral, or both. This combination of pelvic injury could be classified according Young and Burgess classification as LCIII or CM type (Combined Mechanism) and as 61-B3.1 61-B3.2 following AO/OTA classification. Specifically, the upper pubic ramus fracture can be classified according to Nakatani classification as type I medial of the foramen, type II within the foramen and type III lateral to the foramen. The difficulty to deal with these fractures is how to close and reduct the pubic symphysis in mechanically stable way since there is fracture in one or both the upper pubic ramus. The existence of these fractured elements, in this type of pelvis injury allow a lot of degrees of freedom which must be managed from the surgeon in the proper sequence. The incision and the approach are also mandatory for successfully treating these lesions. Anterior Intrapelvic Approach (AIP) or Stoppa approach in conjunction with the first window of ilioinguinal approach is the most appropriate surgical exposure for reduction and fixation.

Compare of Anterior Approaches in Acetabular Fractures Treated by the Standard Ilioinguinal Versus the Stoppa/Iliac Approaches

Background. In acetabular fractures, the correct choice of the surgical approach is mandatory to achieve accurate reduction and to avoid complications. Anterior approaches include the ilioinguinal, the Stoppa, the iliofemoral and the pararectal exposures. The ilioinguinal and the Stoppa approaches are the most ones nowadays. The purpose of the study was to compare the efficacy of modified Stoppa and ilioinguinal approach in the management of acetabular fractures in terms of quality of reduction achieved, complication rates, functional outcomes, operative time, intraoperative blood loss, view angle of the surgical wound, the applicability of the forceps. Materials and Methods. The study enrolled 53 adult patients. We evaluated 53 cases of treatment of patients underwent acetabular fractures osteosynthesis. The patients were divided into two groups. We used the Letournel approach in group 1 (n = 27), the Stoppa/iliac approach — in group 2 (n = 26). The group 2 was split into two subgroups: in subgroup 2A, osteotomy of the anterior superior spine was performed (n = 13), in subgroup 2B, we did not perform it (n = 13). The following parameters were compared: the quality of reposition of fragments, operation time, intraoperative blood loss, damage to neural structures, viewing angle, and ease of use of pelvic instruments for reduction. The functional outcome was assessed by the Majeed scale. Results. Comparison of the two approaches showed that the indices of reduction of fragments, total blood loss and operation time did not differ significantly and were not statistically significant (p0.05). However, there were more neurological complications in group 1, but they did not affect the treatment outcome. The angle of the sector of view during the operation with osteotomy of the anterior superior spine of the pelvic wing is about 90°, which contributes to a more efficient use of repositioning instruments. The functional results of treatment were the same in both groups in 12 months after surgery. Conclusion. The Letournel and the Stoppa/iliac approach are equivalent in terms of the degree of reduction, operation time and blood loss during the operation. Application the Stoppa/iliac approach helps to avoid iatrogenic meralgia paresthetica unlike Letournel approach. The Stoppa/iliac approach and osteotomy of the anterior superior spine provides better visualization and provides a greater degree of freedom for the surgeon during manipulation tools for reposition.

Clinical and Radiological Early Results of Acetabulum Fractures Operated with the Modified Stoppa Approach

Clinical and Radiological Early Results of Acetabulum Fractures Operated with the Modified Stoppa Approach

The efficacy of an anti-protrusio plate in patients with anterior column posterior hemitransverse and associated both column acetabular fractures

IntroductionAcetabular fractures in the elderly population are particularly challenging for orthopedic fracture surgeons to treat. Anterior column posterior hemitransverse (ACH) and both column (BC) fractures account for over 70% of these injuries in geriatric patients. Nonoperative management of these injuries has a mortality of about 79% and patients generally have a minimal chance of return to independent living. The aim of our study was to identify the degree of protrusio deformity geriatric patients with these injuries present with and if indirect reduction through a Stoppa approach was sufficient to improve protrusio deformity. MethodsPatients older than 60 years of age who had ACH and BC pattern acetabular fractures treated at the BIDMC in Boston, MA between 2015 and 2020 were included in this study. Pelvic AP and Judet views were reviewed at injury and each available post-operative follow up. We modified the femoral head extrusion index and used its inverse to measure the level of protrusio at each time point (-FHEI). Patient outcomes were also graded as excellent, good, fair and poor based on post-operative follow up. ResultsSixteen patients were included based on above criteria and average -FHEI at injury was 34.85% and decreased significantly to an average of 21.5% postoperatively and remained stable at all follow up points. At one year follow up (n = 2), the mean -FHEI was 18.15%. Most patients had good (4) or excellent (9) outcomes. ConclusionsWe present short term results of indirect reduction of ACH and BC acetabular fractures in geriatric patients using a PRO quadrilateral surface plate, which was largely successful in controlling the primary protrusio deformity seen in these patients. This allowed for restoration of the anterior column, with limited surgical morbidity through a relatively simple and straightforward surgical approach.

Calcaneal plate bridge reconstruction plate for acetabular fracture involving quadrilateral surface via modified Stoppa approach

To explore the effectiveness of the calcaneal plate bridge reconstruction plate for acetabular fracture involving quadrilateral surface via modified Stoppa approach. Between January 2015 and December 2017, 18 patients with acetabular fracture involving quadrilateral surface were treated with the calcaneal plate bridge reconstruction plate via the modified Stoppa approach. There were 12 males and 6 females. The age ranged from 28 to 63 years (mean, 39 years). The cause of injury was traffic accident in 13 cases and falling from height in 5 cases. According to the Letournel-Judet classification, there were 10 cases of anterior and posterior column fractures, 6 cases of T-shaped fractures, and 2 cases of anterior column and posterior semi-transevere fractures. The interval from injury to operation was 6 to 24 days (mean, 8.6 days). The reduction quality was assessed by postoperative X-ray film and CT according to the criteria proposed by Matta. The hip joint function was assessed by the modified Merled'Aubigné-Postel score. The operation time was 120-240 minutes (mean, 165 minutes) and the intraoperative blood loss was 600-1 400 mL (mean, 850 mL). All patients were followed up 18-30 months (mean, 24.5 months). There were 2 cases of the fat liquefaction of abdominal incisions, 3 cases of intraoperative injury of lateral femoral cutaneous nerve, 1 case of lower limb thrombosis, and 1 case of abdominal pain and hematuria due to intraoperative accidental bladder injury. According to the criteria proposed by Matta, the reduction quality rated as anatomic reduction in 12 cases, satisfactory reduction in 5 cases, and unsatisfied reduction in 1 case, and the satisfaction rate was 94.4%. All fractures healed with the healing time of 3-5 months (mean, 3.4 months). During follow-up, no internal fixator loosening, breakage, or fracture displacement occurred. At last follow-up, according to modified Merled'Aubigné-Postel score, hip joint functions rated as excellent in 11 cases, good in 4 cases, fair in 2 cases, and poor in 1 case. The excellent and good rate was 83.3%. Application of calcaneal plate bridge reconstruction plate via the modified Stoppa approach for the acetabular fracture involving the quadrilateral surface can obtain satisfactory effectiveness.

The Post-operative Outcome of Stoppa Approach in the Treatment of Anterior Column Acetabular Fractures

Background: Choosing the proper approach to surgical treatment of various types of acetabular fractures can play an important role in minimizing adverse outcomes during and after surgery. In the present study, we described our experience on the outcome of Stoppa approach in anterior column acetabular fractures. Methods: This was a retrospective analysis of 40 patients with acetabular anterior column fractures that had undergone surgery with Stoppa approach. The study information, Harris Hip Score (HHS), and pre- and post-operative radiographic findings were collected by reviewing the hospital recorded files. Results: HHSs of 80 to 100 were achieved in 75.0% of patients. Completed (anatomic reduction less than 2 mm) displacement reduction was found in 97.5%. 2 mg/dl decreased serum level of hemoglobin (Hb) was found in 75.0%, leading to blood transfusion in 60% of subjects. Regarding post-procedural complications, the common event was infection in 15.0%, followed by degenerative joint disease (DJD) in 15.0%. The post-operative complications were similar in men and women, but were significantly higher in patientsolder than 50 years than the younger patients. Conclusion: Stoppa approach is associated with high success rate and the occurrence of rare and tolerable major complications.

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

BackgroundAs the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures. MethodsTwenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d’Aubigne and Postel score with a mean follow up of 15.13 months. ResultsThe clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively. ConclusionsMinimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.

Clinico-Radiological Evaluation of Modified Stoppa Approach in Treatment of Acetabulum Fractures.

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.

Comparative study of modified Stoppa approach and ilioinguinal approach for pelviacetabular fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The present study was done to study advantages and disadvantages of modified Stoppa approach (MSA) and ilioinguinal approach (IIA) for surgery of pelviacetabular fractures involving anterior column, anterior wall, quadrilateral plate with protrusion and complex fractures, pelvic ring fractures with pubic diastasis or sacroiliac joint disruptions which needs to be stabilized anteriorly.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Study was conducted in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad on patients with pelviacetabular fractures during June 2018 to March 2020. In our study of 25 patients, they were divided into group A containing 13 patients operated using MSA and group B containing 12 patients operated using IIA. Follow up period was 12-18 months (mean=15) and 12-16 months (mean=14) for group A and B, respectively. Patients assessed using modified Merle d’Aubigné score and Matta’s score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean modified Merle d’Aubigné score was 16 and 14 for group A and B, respectively (p value=0.89). Mean blood loss and operative time were less in MSA. Superficial infection was found in one patient each of group A and B whereas one patient developed deep infection in group B. One patient each of both group had hip pain suggestive of early arthrosis. In group B, two patients developed meralgia paresthetica. One patient developed external iliac artery thrombosis and inguinal hernia in group B. one patient from group A developed incisional hernia.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MSA was better and simpler than IIA with due adequate training and practice to achieve direct access for pelviacetabular fracture reduction and also it requires less operative time, less blood loss and better postoperative outcome.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;