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Treatment of Acetabulum Fractures Through the Modified Stoppa Approach: Strategies and Outcomes

  • Symposium: Fractures of the Acetabulum
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Since the original description by Letournel in 1961, the ilioinguinal approach has remained the predominant approach for anterior acetabular fixation. However, modifications of the original abdominal approach described by Stoppa have made another option available for reduction and fixation of pelvic and acetabular fractures.

Questions/purposes

We evaluated our results in patients with acetabulum fractures with the modified Stoppa approach in terms of (1) hip function as measured by the Merle d’Aubigne hip score; (2) complications; and (3) quality of fracture reduction and percentage of fractures that united.

Methods

Between September 2008 and August 2012, 289 patients with acetabular fractures were treated at our Level I trauma center. Twelve percent (36 of 289) of patients were treated operatively using the modified Stoppa approach. Ninety-seven percent (35 of 36) of our patients had fracture patterns involving displacement of the posterior column. Six (17%) were converted early to a total hip arthroplasty, and 14 (39%) were lost to final followup, leaving 22 of 36 for subjective clinical outcome analysis at a mean of 32 months (range, 9–59 months). Our general indications for this approach during the period in question were fractures of the anterior column and anterior wall, anterior column with posterior hemitransverse fractures, both column fractures, transverse fractures, and T-type fractures. Followup included regularly scheduled office visits with radiographs (AP pelvis, Judet views) that were graded by the treating surgeon and by the authors of this study (MJI, BCT) and patient outcome surveys.

Results

Merle d’Aubigne hip scores were very good in 55% (12 of 22), good in 9% (two of 22), medium in 18% (four of 22), fair in 5% (one of 22), and poor in 14% (three of 22), and 70% (23 of 33) of patients were able to ambulate without any assistive devices. Complications included one superficial infection and three deep infections, two patients with temporary lateral thigh numbness, no obturator nerve palsies, and one inguinal hernia. Three deaths in the cohort were seen in followup as a result of unrelated causes. Radiographic grading of fracture reductions after surgery revealed that 27 (75%) were anatomic, six (17%) were satisfactory, and three (8%) were unsatisfactory. A total of 94% of the fractures united.

Conclusions

In agreement with prior published data, our results show good functional outcomes with minimal complications using the modified Stoppa approach for a variety of acetabular fractures. Our results highlight the difficulty but feasibility in treating posterior column displacement through an anterior approach. Consideration for dual approaches with posterior column involvement may be warranted to optimize fracture reduction and functional outcomes.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Joaquin Castaneda MD, and Kevin Pugh MD, for allowing us to use their patients in this study. We also thank Dr Teresa Wood for her assistance in helping design and obtain all necessary approvals for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Doctors’ Hospital, Columbus, OH, USA

    Mark J. Isaacson DO

  2. Department of Orthopaedic Surgery, Grant Medical Center, Columbus, OH, USA

    Benjamin C. Taylor MD, Bruce G. French MD & Attila Poka MD

  3. OhioHealth Orthopaedic Trauma and Reconstructive Surgery, Grant Medical Center, 285 East State Street, Suite 500, Columbus, OH, 43215, USA

    Benjamin C. Taylor MD

Authors
  1. Mark J. Isaacson DO
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  2. Benjamin C. Taylor MD
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  3. Bruce G. French MD
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  4. Attila Poka MD
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Corresponding author

Correspondence to Benjamin C. Taylor MD.

Additional information

One of the authors (BCT) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period of less than USD 10,000 from DepuySynthes (DePuy Orthopaedics, Inc, Warsaw, IN, USA), Orthobullets.com for editorial staff services (Lineage Medical, LLC, Cambridge, MA, USA), and research grant support from Synthes and the Orthopaedic Trauma Association. One of the authors (BGF) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period of less than USD 10,000 from Biomet (Biomet, Inc, Warsaw, IN, USA) and is on the speakers’ bureau for DepuySynthes. One of the authors (AP) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period of less than USD 10,000 from Biomet and Stryker (Kalamazoo, MI, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Grant Medical Center, Columbus, OH, USA.

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Isaacson, M.J., Taylor, B.C., French, B.G. et al. Treatment of Acetabulum Fractures Through the Modified Stoppa Approach: Strategies and Outcomes. Clin Orthop Relat Res 472, 3345–3352 (2014). https://doi.org/10.1007/s11999-014-3460-x

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  • DOI: https://doi.org/10.1007/s11999-014-3460-x

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