Modified Stoppa Approach in Acetabular Fractures

Ji Wan Kim; Young Chang Kim

doi:10.12671/jkfs.2014.27.4.274

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Kim and Kim: Modified Stoppa Approach in Acetabular Fractures

Original Article

Journal of the Korean Fracture Society 2014; 27(4): 274-280.

Published online: 20 October 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.4.274

Modified Stoppa Approach in Acetabular Fractures

Ji Wan Kim, M.D., Ph.D., Young Chang Kim, M.D., Ph.D.

Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Ji Wan Kim, M.D., Ph.D. Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan 612-896, Korea. Tel: 82-51-797-0990, Fax: 82-51-797-0991, H00106@paik.ac.kr

Received 17 May 2014 Revised 11 July 2014 Accepted 11 July 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the clinical results of modified Stoppa approach in acetabular fractures.

Materials and Methods

Twelve patients who underwent surgery using the modified Stoppa approach for acetabular fractures were enrolled. There were 10 cases of isolated acetabular fracture, two cases of acetabular fracture combined with pelvic ring injury. There were two cases of anterior column fracture, nine cases of both column fracture, and one case of T-type fracture according to Letournel classification. The clinical outcomes were evaluated from Harris hip score (HHS) at postoperative one year and complications. The radiologic result was evaluated according to Matta criteria; anatomical, imperfect, and poor.

Results

According to the radiological results, there were eight cases of anatomical, three cases of imperfect, and one case of poor reduction. The average HHS was 82.5 and 10 patients had excellent or good results. The other two patients had poor results due to lumbosacral plexopathy and poor reduction, respectively. The complication included one case of incomplete sciatic nerve palsy, which was recovered at postoperative three months.

Conclusion

Internal fixation of acetabular fractures using the modified Stoppa approach had satisfactory clinical and radiological outcomes. The modified Stoppa approach can be a useful option for acetabular fractures with appropriate indication and anatomical information.

Keywords: Acetabulum, Acetabular fracture, Modified Stoppa approach

Figures and Tables

Fig. 1

(A) Initial pelvis antero-posterior (AP) image of a 51-year-old female showing both column fracture. (B) Three-dimensional computed tomography (3D CT) reconstruction image showing medial displacement of the quadrilateral surface. (C) Midline incision of skin. (D) Longitudinal incision of rectus abdominis. (E) Deep blunt dissection of the retropubic area (arrow: obturator nerve). (F) Exposed quadrilateral surface (QS) after retraction of obturator nerve and vessel. (G) Direct reduction of QS. (H) Provisionary fixation of plate. (I) Anatomical reduction of QS by buttress plate. (J) Application of a long plate along the pelvic brim. (K) Postoperative pelvis AP (L) Postoperative 3D CT reconstruction image demonstrating anatomical reduction. (M) Pelvis AP at postoperative nine months demonstrating fracture healing and no evidence of joint space narrowing.

Fig. 2

(A) Initial pelvis antero-posterior (AP) image of a 49-year-old male with multiple trauma showing both column fracture with pelvic ring injury. (B) Postoperative pelvis AP showing anatomical reduction of acetabulum and fixation of a contralateral pelvis anterior ring using the modified Stoppa approach. (C) The pelvis AP image at postoperative 12 months demonstrating fracture healing and no evidence of joint space narrowing.

Table 1

Clinical Results According to Quality of Reduction

Notes

Financial support: None.

Conflict of interest: None.

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