Results of modified stoppa approach for anterior column acetabular fractures

Abstract

Introduction: Surgical management of displaced acetabular fractures has become the gold standard after the early work of Le tournel (1–4). The choice of operative approach is dependent on the fracture type, direction of displacement, skin situation at the surgical incision site, and duration from initial injury (5–7). The fractures with the main anterior displacement are approached anteriorly, while those with the main posterior displacement are approached posteriorly. A combined or extended approach is used if the displacement involves both the anterior and posterior parts of the acetabulum. This study presents our experience of internal fixation of the acetabular fractures and pelvic fractures using a newly modified Stoppa approach, which provides closer visualization to the entire anterior column, quadrilateral surface and the pelvic brim portion of the posterior column.Materials and methods: From February 2014 to April 2016, 29 cases of acetabular fractures were treated at our institution. The inclusion criteria for this study consisted of all simple and combined acetabular fracture types with main anterior displacement. And the patients with history of cesarean section, hysterectomy, bladder injury, prostatectomy, or bladder surgery were excluded. All the patients were regularly followed in out patient department at two weeks, six weeks, three months, six months, and one year postoperatively. AP pelvic and Judet radiographs were taken and reviewed by an independent orthopaedic trauma surgeon,Results: In this study 29 patients were followed up, out of which an anatomic reduction was obtained in 24 patients (82.8 %), a satisfactory reduction in four patients (13.8 %) and poor reduction in one patient (3.4 %). All iliac wing fractures were anatomically reduced (n = 29). The Harris hip score was more than 90 points in 11 patients (37.9 %), 80–89 in 16 (55.2 %) and less than 79 in two patients (9 %).Conclusion: Our experience using of the newly modified Stoppa approach for the treatment of acetabular fractures provides excellent access and visualization to the anterior column, quadrilateral surface and sciatic notch, while permitting good to excellent reduction and fixation.