Fixation of Superomedially Displaced Acetabular Fractures Using an Anatomical Suprapectineal Quadrilateral Surface Plate Through Modified Stoppa Approach

Treatment of superomedially displaced acetabular fractures including a quadrilateral surface (QLS) is challenging. We present a surgical technique using an anatomical suprapectineal QLS plate through the modified Stoppa approach and report the availability of this plate to treat this fracture type along with the surgical outcomes. Thirteen consecutive patients (11 men and 2 women) who underwent surgical treatment using an anatomical suprapectineal QLS plate through a modified Stoppa approach for superomedially displaced acetabular fractures between June 2018 and June 2020, were enrolled retrospectively. These fractures included 10 both-column fractures and 3 anterior-column and posterior hemitransverse fractures, which were confirmed on preoperative 3-dimensional computed tomography. Surgical outcomes were clinically assessed using the Postel Merle d’Aubigné (PMA) score and visual analog scale (VAS) score at the final follow-up, and radiological evaluations were performed immediately after the operation and at the final follow-up. The follow-up period was longer than 1 year in all patients with a mean 22.9 months. The mean operation time was 103 min. Anatomical reduction was achieved in 11 (84.6%) patients, while imperfect reduction was achieved in the remaining two (15.3%) patients. At the final follow-up, radiographic grades were excellent, fair, and poor in 11 (84.6%), one (7.6%), and one patient, respectively. The mean PMA score was 16.3 (range, 13-18) and the mean VAS score was 1.0 (range, 0-3). No secondary reduction loss or implant loosening was observed. However, two patients underwent conversion to total hip arthroplasty due to post-traumatic arthritis and subsequent joint pain. No other complications were observed. Simultaneous reduction and fixation using an anatomical suprapectineal QLS plate through the modified Stoppa approach can provide satisfactory outcomes in superomedially displaced acetabular fractures, resulting in shorter operation times and fewer complications.

Comparison of Therapeutic Outcomes of Transabdominal Pararectus Approach and Modified Stoppa Approach in Treating Pelvic and Acetabular Fractures

Objective Pelvic and acetabular fractures are common orthopedic diseases, and this research was to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures. Methods The clinical information of patients with pelvic and acetabular fractures treated surgically in Lu'an Hospital of Chinese medicine, China from January 2016 to April 2020 was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared. Results The patients were followed up for 6–7 months (average, 6.5 months). The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180 ± 41.105 min, 8.667 ± 1.373 cm, 259.667 ± 382 mL and 202.667 ± 32.793 min, 11.600 ± 1.958 cm, and 353.667 ± 590 mL, respectively. The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively. There were significant differences in operation time, incision length, and blood loss between the two groups (p < 0.05). However, there was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p > 0.05). Conclusions The pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures.

Oblique-ilioischial Plate Technique: A Novel Method for Acetabular Fractures Involving Low Level Posterior Column

Background: Complex acetabular fractures involving the anterior and posterior columns are an intractable clinical challenge. The study investigated the safety and efficacy of oblique-ilioischial plate technique for acetabular fractures involving low level posterior column. Methods: A retrospective analysis of 18 patients operated with the oblique-ilioischial plate technique by the modified Stoppa approach (or combined with iliac fossa approach) between August 2016 and July 2021 for low level posterior column acetabular fractures was conducted. The anterior column was fixed with a reconstructed plate from the iliac wing along the iliopectineal line to the pubis. The low level posterior column was fixed with the novel oblique-ilioischial plate running from the ilium to the ischial ramus. Operative time, intraoperative blood loss, reduction quality, and postoperative hip function were recorded.Results: Out of the 18 patients, 10 were male and 8 were female (mean age: 48.6±10.2 years, range: 45–62 years; mean interval from injury to operation: 7.2±1.4 days, range: 5–19 days; mean operative time: 2.1±0.3 h, range: 1. 0–3.2 hours; mean intraoperative blood loss: 300±58.4 mL, range: 200–500 mL). Postoperative reduction (Matta’s criteria) was deemed as excellent (n = 9), good (n = 4), and fair (n = 5). At the final follow-up, the hip function (modified Merle d’Aubigne-Postel scale) was deemed as excellent (n = 11), good (n = 3), and fair (n = 4). The mean union time was 4.5±1.8 months (range: 3–6 months). No implant failure, infection, heterotopic ossification, or neurovascular injury were reported. Conclusion: The oblique-ilioischial plate technique via anterior approach for acetabular fractures involving low level posterior column offers reliable fixation, limited invasion, little intraoperative bleeding, and fewer complications. However, larger multicenter control studies are warranted.

Ilioinguinal versus modified Stoppa approach for open reduction and internal fixation of displaced acetabular fractures: A Protocol for Systematic Review and Meta-Analysis

Background: The fracture of the acetabulum is one of the most challenging fractures to manage and operate for orthopaedic surgeons, to get a good surgical outcome, anatomical reduction of fractures and reconstruction of the joint is of utmost importance. To achieve a good postoperative outcome an appropriate surgical approach is necessary to achieve an anatomical reduction of fractures and fewer complications. Objective: The current review aims to compare the outcomes of the ilioinguinal versus modified Stoppa approach for open reduction and internal fixation (ORIF) of displaced acetabular fractures by analyzing the evidence from the current literature. Methods: A systematic review of the literature will be conducted in accordance with the PRISMA guidelines. The primary searches will be conducted on the Medline (PubMed), Embase, Scopus, and Cochrane Library databases, using a pre-defined search strategy. The studies of any design in the English language will be included which compared the outcomes of the ilioinguinal and modified Stoppa approach for ORIF of displaced acetabular fractures and reported at least one outcome of interest. Studies that do not compare the outcomes of the ilioinguinal and modified Stoppa approach for the treatment of displaced acetabular fractures in adults (>18 years of age), case reports, conference abstracts, posters, book chapters, review articles, biomechanical studies, technical tips, cadaveric studies, and articles not in the English language will be excluded. Both qualitative and quantitative analyses will be done. Qualitative analysis will be done using appropriate tables and diagrams. Wherever feasible, quantitative analysis to be done with the appropriate software. The risk-of-bias assessment will be done using the MINORS tool for the non-randomized comparative studies, and The Cochrane Collaboration risk-of-bias tool will be used for randomized control trials.

Intra-Pelvic Penetration of Broken Guide Wire during Fixation of Hip Fracture: Presentation of a Case and Review of Literature

Background: The application of a cannulated device is a widely used fixation method for hip fractures. Although the breakage of the guide wire during this procedure is an uncommon complication, migration of the broken fragment might be catastrophic. Case Report: We presented a case of intertrochanteric fracture with breakage of the lag screw guide wire in the acetabulum during fixation with cephalomedullary nail. The broken fragment was located with computed tomography (CT) scan and removed through Stoppa approach. Conclusion: We found the Stoppa approach a safe and useful method for extracting the intra-pelvic broken guide wire.

Treatment sequence of combined pelvic injury, consisted of upper pubic ramus fracture, sacroiliac joint dislocation with open book injury, using Stoppa approach

Among pelvic serious injuries is the so-called “open book” injury of the pelvis, with Sacroiliac Joint Disruption (SIJD) in combination with upper pubic ramus or anterior column fracture, contralateral or ipsilateral, or both. This combination of pelvic injury could be classified according Young and Burgess classification as LCIII or CM type (Combined Mechanism) and as 61-B3.1 61-B3.2 following AO/OTA classification. Specifically, the upper pubic ramus fracture can be classified according to Nakatani classification as type I medial of the foramen, type II within the foramen and type III lateral to the foramen. The difficulty to deal with these fractures is how to close and reduct the pubic symphysis in mechanically stable way since there is fracture in one or both the upper pubic ramus. The existence of these fractured elements, in this type of pelvis injury allow a lot of degrees of freedom which must be managed from the surgeon in the proper sequence. The incision and the approach are also mandatory for successfully treating these lesions. Anterior Intrapelvic Approach (AIP) or Stoppa approach in conjunction with the first window of ilioinguinal approach is the most appropriate surgical exposure for reduction and fixation.