Modified Stoppa approach for treatment of acetabular fractures

Abstract

Objectives:The purpose of this work was to assess the clinical and imaging outcomes of the modified Stoppa technique for surgical management of acetabular fractures. Methods: Between September 2019 and November 2021, twenty-one individuals (mean age 39.09 years; range 18-64) who received surgical therapy for acetabular fractures with modified Stoppa participated in the research. The average follow-up period was 12.95 months, with a range of 6 to 24. The data were examined for perioperative difficulties, loss of blood, effectiveness of reductions, fractures patterns, and time to surgery and operation time. There were three levels of reduction quality: poor, imperfect, and anatomic. The functional assessment was done using the Merle d' Aubigne score. Results: Among the 21 acetabulum fractures, 10 were associated with both columns, 5 were anterior column, 3 were T-type fractures, 2 were transverse and one case was anterior column/posterior hemitransverse. Incisions along the pfannenstiel were utilized in 9 patients and vertical midline incisions in the other twelve. In 18 (85%) of the individuals, supplementary lateral windows were employed, with an average duration until surgery of 7.8 days. The typical loss of blood during surgery was 780 mL, and the procedure took 239 minutes. In 14 (66.6%), 6 (25.8%), and 1 (5%) of the fractures of the acetabulum, respectively, the radiological results were anatomic, satisfactory, and poor. According to Merle D'Aubigne scores, fifteen patients out of 21 (71.4%) regained their pre-injury activity level. Seven participants were excellent while eight participants were good. Four participants were fair while two were poor. The functional result was significantly affected by occupation and time lag. All fractures were seen to be united radiographically by six months after surgery. No cases of redisplacement were detected. no instances of delayed union or nonunion was existed. No Heterotopic ossification was observed. According to Matta scoring, There were seven excellent cases (33.33%), nine good cases (42.8%) two fair cases (9.5%) and three poor cases (14.2%).On studying the complications, we had two cases of vascular complications, one case of sciatic nerve injury and five cases of paresthesia of the lateral cutaneous nerve. Five cases developed postoperative infection. Only one of them who had poor results. Conclusion: Despite of being technically demanding, the results of this research demonstrate that the modified Rives-Stoppa technique, when used for treating acetabular fractures, usually results in satisfactory to excellent reduction. Additionally, it provides outstanding accessibility and visibility to the posterior column, quadrilateral surface, and corona mortis. This method avoids the need for inguinal canal and femoral neurovascular bundle dissection and repair surgery.