Modified Stoppa approach for acetabular fracture fixation – reduction techniques

Abstract

Introduction: Since acetabular fractures are intra-articular, accurate anatomic reduction is essential to achieve a good functional outcome. Among the various surgical approaches, ilioinguinal and modified Stoppa approaches are the only available intra-pelvic approaches. Even though ilioinguinal approach is more commonly used, modified Stoppa approach is becoming more popular due to the possibility of visualising and reducing quadrilateral plate fragments as well as fixation of posterior column through anterior approach. The aim of our study was to assess the efficacy of various reduction tools/ techniques for reduction and fixation of fractures operated using modified Stoppa approach. Materials and Methods: We have operated on 16 patients with acetabular fractures through modified Stoppa approach in the age group of 19 years to 70 years (mean 42 years) with male female ratio of 13:3. In patients requiring combined approach, the anterior approach was done first. In all the patients, modified Stoppa was combined with a lateral window. We have used various reduction techniques including transtrochanteric Schanz pin, intra-focal elevators, ball spike, bone hook, iliac crest Schanz pin, Farabeuf forceps, undercontoured plate, etc. Results: Matta's radiographic reduction criteria showed anatomic reduction in 10 cases. Clinical assessment using Merle d' Aubigne scoring showed excellent results in 9 cases and good results in 6 cases. Follow up was done for a maximum period of six months. Conclusion: Modified Stoppa approach provides better visualisation of quadrilateral surface and sciatic buttress when compared to the ilioinguinal approach. The use of appropriate reduction techniques helps in achieving good reduction of anterior column, at the same time provides opportunity to fix the posterior column from the anterior aspect using anterior to posterior column screws, obviating the need for a separate posterior approach.