TREATMENT OF ACETABULAR ANTERIOR AND POSTERIOR COLUMN FRACTURES BY MODIFIED Stoppa APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIDongzhe ,  FANGYue , ZOUChang , HUANGFuguo , LIULei , XIANGZhou , YANGTianfu

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

FANGYue, Email: fangyue1968@163.com

Keywords：

Acetabular fracture; Internal fixation; Modified Stoppa approach; Ilioinguinal approach

DOI：

10.7507/1002-1892.20160275

Video：

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Objective To evaluate the surgical techniques, perioperative complications, clinical outcomes of the modified Stoppa approach in the treatment of acetabular anterior and posterior column fractures. Methods Between March 2008 and October 2014, 42 cases of acetabular anterior and posterior column fractures were treated by modified Stoppa approach or modified Stoppa approach combined with iliac fossa approach, and the clinical data were retrospectively analyzed. There were 20 females and 22 males with an average age of 43.2 years (range, 19-68 years). Fractures were caused by traffic accident in 21 cases, by falling from height in 16 cases, and by heavy pound in 5 cases. The time from injury to operation was 3-15 days (mean, 6 days). According to fracture classification of Letournel-Judet, there were 20 cases of both column fractures, 15 cases of anterior and posterior hemi-transverse fractures and 7 cases of T-shaped fractures. The intraoperative blood loss, the amount of blood transfusion, the operation time, the volumn of drainage, and complication were recorded. Matta radiological standard was used to evaluate the reduction quality of fracture, and Merled'Aubigné-Postel system to evaluate hip function. Results The average intraoperative blood loss was 900 mL; the average amount of blood transfusion was 400 mL; the average volume of drainage was 110 mL; and the average operation time was 165 minutes. Intraoperative complications included 4 cases of tractive injury of obturator nerve and 2 cases of the external iliac vein injury, and postoperative complications included 2 cases of lateral femoral cutaneous nerve palsies and 1 case of deep vein embolism of lower extremity, which were improved after treatment. The patients were followed up 36 months on average (range, 12-48 months). There was no infection or heterotopic ossification. According to Matta radiological evaluation system, the reduction quality of fractures was rated as excellent in 21 cases, good in 16 cases, and poor in 5 cases, with an excellent and good rate of 88.1%. The healing time of fracture was 3.5-8.0 months (mean, 5.1 months). According to Merled'Aubigné-Postel system for hip function, 20 cases were graded as excellent, 15 cases as good, 4 cases as fair, and 3 cases as poor, with an excellent and good rate of 83.3% at last follow-up. Conclusion Modified Stoppa approach or with iliac fossa approach can get full exposure of quadrilateral area, good reduction, and firm internal fixation in the treatment of acetabular fractures associated with T-shaped fractures, both column fractures, anterior and posterior hemi-transverse fractures.

Citation： LIDongzhe, FANGYue, ZOUChang, HUANGFuguo, LIULei, XIANGZhou, YANGTianfu. TREATMENT OF ACETABULAR ANTERIOR AND POSTERIOR COLUMN FRACTURES BY MODIFIED Stoppa APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1344-1348. doi: 10.7507/1002-1892.20160275 Copy

1.	Giannoudis PV, Pohlemann T, Bircher M. Pelvic and acetabular surgery within Europe: the need for the co-ordination of treatment concepts. Injury, 2007, 38(4): 410-415.
2.	Dailey SK, Archdeacon MT. Open reduction and internal fixation of acetabulum fractures: does timing of surgery affect blood loss and OR time? J Orthop Trauma, 2014, 28(9): 497-501.
3.	Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. J Bone Joint Surg (Am), 1964, 46: 1615-1646.
4.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
5.	d'Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am), 1954, 36-A(3): 451-475.
6.	Routt ML, Swiontkowski MF. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg (Am), 1990, 72(6): 897-904.
7.	Giannoudis PV, Grotz MR, Papakostidis C, et al. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg (Br), 2005, 87(1): 2-9.
8.	Pavelka T, Houcek P. Complications associated with the surgical treatment of acetabular fractures. Acta Chir Orthop Traumatol Cech, 2009, 76(3): 186-193.
9.	朱仕文, 王满宜, 吴新宝, 等.经单一髂腹股沟入路治疗复合髋臼骨折.中华创伤骨科杂志, 2005, 7(11): 1025-1027.
10.	Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed. Berlin, Germany: Springer-Verlag, 1993: 12-17.
11.	Ma K, Luan F, Fang Y, et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics, 2013, 36(10): e1307-1315.
12.	Shazar N, Eshed I, Ackshota N, et al. Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified rives-stoppa) surgical approaches. J Orthop Trauma, 2014, 28(6): 313-319.
13.	Hirvensalo E, Lindahl J, Kiljunen V. Modified and new approaches for pelvic and acetabular surgery. Injury, 2007, 38(4): 431-441.
14.	Hammad AS, El-khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches. Injury, 2015, 46(2): 320-326.
15.	Märdian S, Schaser KD, Hinz P, et al. Fixation of acetabular fractures via the ilioinguinal versus pararectus approach: a direct comparison. Bone Joint J, 2015, 97-B(9): 1271-1278.
16.	Keel MJ, Ecker TM, Cullmann JL, et al. The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg (Br), 2012, 94(3): 405-411.
17.	Bastian JD, Savic M, Cullmann JL, et al. Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa. Injury, 2016, 47(3): 695-701.
18.	Shin JK, An SJ, Go TS, et al. Analysis of predictors of results after surgical treatment of acetabular fractures. Hip Pelvis, 2015, 27(2): 104-109.
19.	Alexa O, Malancea RI, Puha B, et al. Results of surgical treatment of acetabular fractures using Kocher-Langenbeck approach. Chirurgia (Bucur), 2013, 108(6): 879-885.
20.	Isaacson MJ, Taylor BC, French BG, et al. Treatment of acetabulum fractures through the modified Stoppa approach: strategies and outcomes. Clin Orthop Relat Res, 2014, 472(11): 3345-3352.

1. Giannoudis PV, Pohlemann T, Bircher M. Pelvic and acetabular surgery within Europe: the need for the co-ordination of treatment concepts. Injury, 2007, 38(4): 410-415.
2. Dailey SK, Archdeacon MT. Open reduction and internal fixation of acetabulum fractures: does timing of surgery affect blood loss and OR time? J Orthop Trauma, 2014, 28(9): 497-501.
3. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. J Bone Joint Surg (Am), 1964, 46: 1615-1646.
4. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
5. d'Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am), 1954, 36-A(3): 451-475.
6. Routt ML, Swiontkowski MF. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg (Am), 1990, 72(6): 897-904.
7. Giannoudis PV, Grotz MR, Papakostidis C, et al. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg (Br), 2005, 87(1): 2-9.
8. Pavelka T, Houcek P. Complications associated with the surgical treatment of acetabular fractures. Acta Chir Orthop Traumatol Cech, 2009, 76(3): 186-193.
9. 朱仕文, 王满宜, 吴新宝, 等.经单一髂腹股沟入路治疗复合髋臼骨折.中华创伤骨科杂志, 2005, 7(11): 1025-1027.
10. Letournel E, Judet R. Fractures of the Acetabulum. 2nd ed. Berlin, Germany: Springer-Verlag, 1993: 12-17.
11. Ma K, Luan F, Fang Y, et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics, 2013, 36(10): e1307-1315.
12. Shazar N, Eshed I, Ackshota N, et al. Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified rives-stoppa) surgical approaches. J Orthop Trauma, 2014, 28(6): 313-319.
13. Hirvensalo E, Lindahl J, Kiljunen V. Modified and new approaches for pelvic and acetabular surgery. Injury, 2007, 38(4): 431-441.
14. Hammad AS, El-khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches. Injury, 2015, 46(2): 320-326.
15. Märdian S, Schaser KD, Hinz P, et al. Fixation of acetabular fractures via the ilioinguinal versus pararectus approach: a direct comparison. Bone Joint J, 2015, 97-B(9): 1271-1278.
16. Keel MJ, Ecker TM, Cullmann JL, et al. The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation. J Bone Joint Surg (Br), 2012, 94(3): 405-411.
17. Bastian JD, Savic M, Cullmann JL, et al. Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa. Injury, 2016, 47(3): 695-701.
18. Shin JK, An SJ, Go TS, et al. Analysis of predictors of results after surgical treatment of acetabular fractures. Hip Pelvis, 2015, 27(2): 104-109.
19. Alexa O, Malancea RI, Puha B, et al. Results of surgical treatment of acetabular fractures using Kocher-Langenbeck approach. Chirurgia (Bucur), 2013, 108(6): 879-885.
20. Isaacson MJ, Taylor BC, French BG, et al. Treatment of acetabulum fractures through the modified Stoppa approach: strategies and outcomes. Clin Orthop Relat Res, 2014, 472(11): 3345-3352.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF ACETABULAR ANTERIOR AND POSTERIOR COLUMN FRACTURES BY MODIFIED Stoppa APPROACH

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