J Korean Fract Soc.  2014 Oct;27(4):274-280. 10.12671/jkfs.2014.27.4.274.

Modified Stoppa Approach in Acetabular Fractures

• Kim JW
• Kim YC

• KMID: 2015482
• DOI: http://doi.org/10.12671/jkfs.2014.27.4.274

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.

Keyword

Acetabulum; Acetabular fracture; Modified Stoppa approach

MeSH Terms

Acetabulum*
Classification
Hip
Humans
Sciatic Neuropathy

Figure

• 

  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.

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  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.

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