J Korean Fract Soc.  2017 Jul;30(3):131-136. 10.12671/jkfs.2017.30.3.131.

Reduction Technique of Dome Impaction Using the Modified Stoppa Approach: A Technical Note

• Kim JW
• Seo YM
• Jang HS

• KMID: 2424121
• DOI: http://doi.org/10.12671/jkfs.2017.30.3.131

Abstract

In elderly acetabular fractures, central dislocation of the femoral head and impacted superior dome of the acetabulum is common. Unreduced dome impaction can lead to degenerative arthritis and results in poor results. Herein, we present a case of operative reduction and fixation performed via the modified Stoppa approach in acetabular fracture with superior dome impaction.

Keyword

Acetabulum; Acetabular fracture; Dome impaction; Approach; Stoppa approach

MeSH Terms

Acetabulum
Aged
Dislocations
Head
Humans
Osteoarthritis

Figure

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  Fig. 1 A 65-year-old man with acetabular factures. (A) Radiograph of right acetabular fracture involving both columns, with a medially displaced quadrilateral plate and superior dome impaction. (B) Coronal reconstruction computed tomography (CT) showing impacted fragment at the acetabular dome. (C) Sagittal reconstruction CT showing 2 pieces of impacted fragment. (D) Immediate postoperative pelvis anteroposterior image, showing a good reduction through the modified Stoppa approach. (E, F) Postoperative CT images, showing well-reduced dome impaction and congruent joint.

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  Fig. 2 (A) Good function at the 6-month postoperative follow-up. (B-D) Pelvis x-ray at 10 months after surgery.

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  Fig. 3 Surgical technique. (A) Patient positioning. (B) Intraoperative fluoroscopy image showing widening of the joint space. (C) Longitudinal incision of rectus abdominis. (D) Deep blunt dissection of the retropubic area. (E) Deep dissection of the quadrilateral plate (arrow: obturator nerve). (F) Confirmation of the position of impacted fragments with a probe under fluoroscopic image. (G) Reduction of impacted fragments. (H, I) Fluoroscopic images of impacted fragments, before and after reduction, respectively. (J) Indirect reduction of the anterior column with a 3.5 mm locking compression plate. (K) Insertion of a K-wire (guide wire). (L) Advance to the quadrilateral surface of the guide wire after reduction of the posterior column. (M) Insertion of a 4.0 cannulated screw. (N) Preparing of a pre-bended reconstruction plate. (O) Passing the long reconstruction plate along the pelvic brim. (P) Insertion of two screws to fix the posterior column after insertion of the screws to the posterior ilium and reduction of the posterior column with a collinear clamp. (Q) Insertion of screws to the pubis.

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