THE STOPPA APPROACH FOR ACETABULAR FRACTURES

Abstract

Background: Surgical approaches to the acetabular fracture present a challenge for most surgeons. The ilioinguinal approach by Letournel has fundamentally contributed to the successful treatment of such fractures. The current tendency is to minimize the approach while maintaining a proper visual field that allows inspection of fracture fragments and the ability to reduce them. The Stoppa approach is a less invasive anterior intra-pelvic approach that could be combined with a lateral window of the ilioinguinal approach, especially helpful in facilitating the approach to the quadrilateral plate.

Aim: To evaluate the efficacy and safety of the Stoppa approach for the treatment of different types of acetabular fractures.

Patients: Between the years 2004 and 2006, 45 patients with acetabular fractures were operated on using the Stoppa approach. Their age ranged between 14 and 73 (average 42). There were 33 males and 12 females whose fractures were classified as anterior column fractures (21) associated both columns (11) transverse (6), T-shape and other various types. They were consecutively operated in two level 1 trauma centers; in 13 the Stoppa approach was used solely and in the others a combination of the Stoppa approach with an iliac window was employed. Patients were followed for an average of 11.4 months (range 2–36 months), and assessed using the Merle d’Aubigné score.

Results: Visualization of the fracture, reduction and fixation were all feasible through the Stoppa approach. The average length of surgery was 4 hours and an average of intraoperative bleeding was 1086 cc. We were able to achieve excellent reduction in 37 patients and a good reduction in the rest of the cases. Clinical outcomes were good to excellent in 90% of the patients. 3 patients underwent hip arthroplasty due to post traumatic osteoarthritis.

Conclusions: The Stoppa approach in combination with an iliac window offers superb visualization of the quadrilateral plate, anterior column and in some cases the posterior column as well and enables excellent reduction. It is a reasonable replacement for the iliuinguinal approach offering less tissue dissection.