Modified Stoppa Approach for Acetabulum Fracture: A Review

Soni, Ashwani; Gupta, Ravi; Sen, Ramesh

doi:10.1016/j.rboe.2017.09.006

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Revista Brasileira de Ortopedia

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Review Article • Rev. bras. ortop. 54 (02) • Mar-Apr 2019 • https://doi.org/10.1016/j.rboe.2017.09.006 copy

Modified Stoppa Approach for Acetabulum Fracture: A Review^* * Study conducted at Department of Orthopedics, Government Medical College and Hospital, Chandigarh, India. Publishied originally by Elsevier Editora Ltda.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Fracture acetabulum is a grave injury and a challenge for orthopedic surgeons. Anterior and posterior approaches have been described for fixation of acetabulum fractures. The modified Stoppa approach is considered an alternate to anterior approach, which provides access to pelvis from inside the cavity. The purpose of this article is to review the available literature on use of the modified Stoppa approach in acetabulum fractures. The available data suggest that modified Stoppa approach is useful in anterior acetabulum fractures and some posterior acetabulum fractures, especially where buttressing of medial wall is required.

Keywords:
acetabulum; fractures bone; fracture fixation; modified stoppa

Sr no		No of patients	Approach
1	Elmadag et al³³33 Elmadag M, Guzel Y, Aksoy Y, Arazi M. Surgical Treatment of Displaced Acetabular Fractures Using a Modified Stoppa Approach. Orthopedics 2016;39(02):e340-e345	36	MS
2	Hammad et al⁴²42 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 (02):320-326	21	MS ± LW14% requires KL
3	Kim et al³⁴34 KimHY, Yang DS, Park CK, Choy WS.Modified Stoppa approach for surgical treatment of acetabular fracture. Clin Orthop Surg 2015;7 (01):29-38	22	MS – 13MS + KL – 9 (5 ACPHT, 4 Trans + PW)MS + LW – 2
4	Rocca et al²⁹29 Rocca G, Spina M, Mazzi M. Anterior Combined Endopelvic (ACE) approach for the treatment of acetabular and pelvic ring fractures: A new proposal. Injury 2014;45(Suppl 6):S9-S15	34	MS + LW (Ace approach)
5	Elmadag et al⁴⁰40 Elmadag M, Güzel Y, Acar MA, Uzer G, Arazi M. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res 2014;100 (06):675-680	17	MS
6	Shazar et al³⁸38 Shazar N, Eshed I, Ackshota N, Hershkovich O, Khazanov A, Herman A. Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified Rives-Stoppa) surgical approaches. J Orthop Trauma 2014;28(06):313-319	103	MS – 32MS + LW – 57MS + KL – 11MS + MW + LW - 2MS + SP - 1
7	Laﬂamme and Herbert-Davies³⁷37 Laflamme GY, Hebert-Davies J. Direct reduction technique for superomedial dome impaction in geriatric acetabular fractures. J Orthop Trauma 2014;28(02):e39-e43	9	MS + LW
8	Casstevens et al³⁶36 Casstevens C, Archdeacon MT, d&Heurle A, Finnan R. Intrapelvic reduction and buttress screw stabilization of dome impaction of the acetabulum: a technical trick. J Orthop Trauma 2014;28(06): e133-e137	10	MS
9	Liu et al³⁵35 Liu Y, Yang H, Li X, Yang SH, Lin JH. Newly modified Stoppa approach for acetabular fractures. Int Orthop 2013;37(07): 1347-1353	29	MS + LW (Newly modified stoppa approach)
10	Ma et al³⁹39 Ma K, Luan F, Wang X, Ao Y, Liang Y, Fang Y, et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics 2013;36(10): e1307-e1315	30	MS – 8MS + LW – 22
11	Anderson et al³⁰30 Andersen RC, O'Toole RV, Nascone JW, Sciadini MF, Frisch HM, Turen CW. Modified stoppa approach for acetabular fractures with anterior and posterior column displacement: quantification of radiographic reduction and analysis of interobserver variability. J Orthop Trauma 2010;24(05):271-278	17	MS + Post app – excluded from studyMS + LW – includedExact no not mentioned
12	Sagi et al³¹31 Sagi HC, Afsari A, Dziadosz D. The anterior intra-pelvic (modified rives-stoppa) approach for fixation of acetabular fractures. J Orthop Trauma 2010;24(05):263-270	57(7 sklt immature)	MS – 23MS + LW – 34 (additional SM in 2 pt)(AIP approach)
13	Isaacson et al⁴¹41 Isaacson MJ, Taylor BC, French BG, Poka A. Treatment of acetabulum fractures through the modified Stoppa approach: strategies and outcomes. Clin Orthop Relat Res 2014;472(11):3345-3352	36	MS + LW – 23MS + KL – 3
14	Laﬂamme et al³²32 Laflamme GY, Hebert-Davies J, Rouleau D, Benoit B, Leduc S. Internal fixation of osteopenic acetabular fractures involving the quadrilateral plate. Injury 2011;42(10):1130-1134	21	MS + LW
15	Cole and Bolhofner⁷7 Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res 1994;(305):112-123	55	Only MS – 32MS + KL – 18 primarily anterior approach)(6 patients required lateral Avila approach in addition to primarily anterior approach)
16	Dailey and Archdeacon⁴³43 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(09):497-501	112	AIP approach (as described by Sagi HC et al⁹9 Bible JE, Choxi AA, Kadakia RJ, Evans JM, Mir HR. Quantification of bony pelvic exposure through the modified Stoppa approach. J Orthop Trauma 2014;28(06):320-323)

Complications	No of patients	Management
Intra operative complications
Corona mortis injury	2	Packing and ligation in 1 patientDetails of 1 patient not mentioned
Obturator artery injury	1	Packing and ligation
External iliac vein injury	1	Primary repair
Superior gluteal artery injury	1	Packing and embolization
Post-operative complications
Obturator nerve injury	21	Recovered in 3–6 months in 20 patientsPartial recovery in 1 patient
Deep infection	13	Debridement and antibiotics in 11 patientsDebridement, antibiotics and plate removal in 1 patientHip joint fusion in 1 patient
Lateral femoral cutaneous nerve palsy	8	Recovered in 3–6 months in 5 patientsDetails not mentioned for 2 patients
Foot drop	5	Recovered in 6–12 months
Superficial infection	5	Dressing and antibiotics
Deep vein thrombosis	7	Chemical prophylaxis in 1 patient
		Details not mentioned for 3 patients
Intra articular screw	2	Removed
Sciatic nerve palsy	1	Recovered in 6 weeks
Seroma at operative site	1	Treated operatively, no infection was found
Peritoneum breach	1	Wound was closed without sequelae
Wound dehiscence	1	Surgical closure done
Delayed wound healing	1	Healed in 3 weeks with infra-red heat lamp treatment
Late complications
Hip joint arthritis	15
Ectopic bone formation	9	Conservative in 3 patients with full range of motionDetails not mentioned for 6 patients
Avascular necrosis femur head	5
Loss of reduction	4	THR done in 2 patientsDetails not mentioned for 2 patients
Rectus atrophy without hernia	2
Lateral inguinal hernia	4	Repair done
Non-union	1	Fixation and bone grafting at 10 months
Other complications
Fatal pulmonary embolism	2
Non-fatal pulmonary embolism	1
Stroke	1
Common iliac artery thrombosis	1
Fatal liver cirrhosis	1

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence
Ashwani Soni, Department of Orthopedics, Government Medical College and Hospital, Chandigarh, India (e-mail: asoniortho@gmail.com).

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Modified Stoppa Approach for Acetabulum Fracture: A Review* * Study conducted at Department of Orthopedics, Government Medical College and Hospital, Chandigarh, India. Publishied originally by Elsevier Editora Ltda.

Abstract

Modified Stoppa Approach for Acetabulum Fracture: A Review^* * Study conducted at Department of Orthopedics, Government Medical College and Hospital, Chandigarh, India. Publishied originally by Elsevier Editora Ltda.