Modified Stoppa's approach as "all fractures through one approach" for fractures of the acetabulum and pelvis.

Abstract

Background: The modified Stoppa approach has gained widespread acceptance for managing acetabular fractures. This study explores its effectiveness as a comprehensive solution for a majority of acetabular, pelvic and combined injuries.

Material and methods: This prospective study enrolled 27 patients [21 males, 6 females, mean age 45.4 years] with acetabular fractures and pelvic injury fulfilling the inclusion criteria. The modified Stoppa approach with a transverse incision was used in all cases. The brim plate was used to fix the anterior column, the infra-pectineal plate, hook plate and lag screws were used to fix the posterior column. Symphyseal and ramus fixation was done using a recon plate and the sacroiliac joint was fixed with illiosacral screws. The mean follow up was 3.21 years. The radiological and functional outcome was evaluated by Matta's criteria and the modified D'Aubigne and Postel criteria, respectively, for acetabular fractures and the Matta and Tornetta criteria and Majeed's score, respectively, for pelvic fractures.

Results: There were 24 acetabular fractures and 4 pelvic injuries (including 1 combined injury). Average blood loss and operation times were 750 mL and 140 min, respectively. Among 24 acetabular fractures, 22 had congruent reduction and 2 had non-congruent reduction. Functional outcome was excellent in 7, good in 11, fair in 4 and poor in 2 patients. Among 4 pelvic fractures, 2 had excellent and 2 had good reduction. Majeed's score was excellent in 1 and good in 2 patients (the patient with a combined injury had an excellent functional outcome).

Conclusions: 1. This study confirms the efficacy and safety of the modified Stoppa approach in treating anterior injuries of the acetabulum. 2. This study also underlines the possibility of managing the minimally displaced posterior column injuries and a good portion pelvic ring injuries through anterior approach. 3. The modified Stoppa approach may be considered a workhorse approach for treating a majority of acetabular fractures.