A randomized controlled trial comparing the outcomes of the modified Stoppa and ilioinguinal approaches in the surgical treatment of acetabular fractures.

Background: The Stoppa approach was modified to manage fractures of the anterior column as an alternative to the ilioinguinal approach to reduce complications. A debate persists regarding the superiority of one approach over the other. Therefore, in the present study we performed a randomized controlled trial (RCT) to investigate the following hypotheses: (1) Whether the modified Stoppa approach leads to reduced blood loss, (2) Whether the functional and radiological outcomes with the modified Stoppa approach are superior to those with the ilioinguinal approach, and (3) Whether the complication rates differ between the two approaches.

Methods: A total of 92 patients were initially enrolled in the study. After applying exclusion criteria and obtaining informed consent, 60 patients with acetabular fractures were randomly allocated into two groups and underwent internal fixation at our tertiary care hospital using either the ilioinguinal approach or the modified Stoppa approach. Bleeding and surgical time was evaluated intraoperatively. Post-operative evaluation of wound drainage and neurovascular status was done. Post-operative radiographs reduction assessment of reduction was done as per Matta scoring and clinically Merle D'Aubigne score was compared at 12 months. All data were statistically analyzed with non-parametric tests by using SPSS 20.0 software.

Results: Among the studied population, 48.3 % cases (21.6 % and 26.7 % with ilioinguinal and modified Stoppa approach, respectively) of all patients exhibited excellent radiological outcomes. Additionally, 33.3 % (15 % with the ilioinguinal approach and 18.3 % with the modified Stoppa approach) achieved an excellent clinical score based on the Merle D'Aubigne criteria at 12 months. However, no significant difference was found between two approaches. Both the approaches offer adequate exposure however; quadrilateral surface is directly visualised with the modified Stoppa approach. Considering two significant findings, i.e., reduced intra-operative blood loss and shorter surgical duration was associated with the modified Stoppa approach.

Conclusion: Notably, in the context of the ongoing debate between proponents of these two approaches, our study presents a valuable contribution. Overall, the modified Stoppa approach is a better choice in treating anterior acetabular fractures.