Received 04/09/2020
Review began 04/14/2020
Review ended 04/14/2020
Published 04/24/2020
© Copyright 2020
Jain et al. This is an open access
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Clinico-radiological Outcomes of Using
Modified Stoppa Approach for Treating
Acetabular Fractures: An Institutional
Review
Mantu Jain , Pankaj Kumar , Sujit K. Tripathy , Sudarsan Behera II , Rajesh Rana ,
Sudhanshu Das
1. Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND 2. General Surgery, All India
Institute of Medical Sciences, Bhubaneswar, IND 3. Orthopaedics, All India Institute of Medical Sciences,
Bhubaneshwar, IND 4. Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
Corresponding author: Sudarsan Behera II, sudarsanctc@gmail.com
Abstract
Introduction
Acetabular fractures are complex intra-articular fractures. The extra-pelvic ilioinguinal (IL) has
been the workhorse for the anterior approach and remains the gold standard. The major
difference between the IL and the Stoppa approaches is that Stoppa allows for the avoidance of
the middle window of the IL approach. Hence, the modified Stoppa approach (MSA) can be
adopted by a comparatively less experienced surgeon with minimal complications. The purpose
of this study is to evaluate the radiological and functional outcomes of patients operated on
using the MSA.
Materials and methods
Patients operated on by the MSA for acetabular fractures with a minimum of one year of
clinical and radiographic follow-ups were reviewed. CT scans and radiographs were evaluated
for the fracture pattern, time to surgery, operative time, blood loss, quality of reduction (Matta
criterion), FO [Harris hip score (HHS) and Nach Merle d'Aubigné and Postel score (NMAPS)] and
complications (perioperative and follow-up). Twenty-three of 26 patients with 45
acetabular fractures operated between January 2016 and November 2018 were included.
Descriptive statistics were used for demographic data, and Pearson’s chi-squared statistic was
calculated for the association between radiological and functional outcomes.
Results
Among the 23 patients, the mean age was 38.5 years (range: 15-65) with a male-to-female ratio
of 18:5. The average time to surgery was 11.5 days (range: 2-32), operating time was 155
minutes (range: 90-243), and average blood loss was 650 ml (range: 500-1,250). A supplemental
lateral window was used in 20 patients (87%), and three underwent the combined anterior and
posterior [Kocher Langenbacks (KL)] approach. All cases were unilateral. The transverse fracture
was the most common pattern (eight patients) followed by the associated both-column fracture
in six and T-type, isolated anterior column fracture, and anterior column and posterior hemi-
transverse fractures seen in three patients each. Iliac blade (high anterior column) fracture was
seen in 14 cases and one patient had associated sacral type II fracture. Road traffic accidents
accounted for 61% of the injuries and injury severity score (ISS) of >15 (polytrauma) was seen in
more than 50% of the cases (associated with other organ injuries). The radiological outcome
was anatomical in 52% of the cases, imperfect in 39%, and poor in 9%. The functional outcomes
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Open Access Original
Article DOI: 10.7759/cureus.7821
How to cite this article
Jain M, Kumar P, Tripathy S K, et al. (April 24, 2020) Clinico-radiological Outcomes of Using Modified
Stoppa Approach for Treating Acetabular Fractures: An Institutional Review. Cureus 12(4): e7821. DOI
10.7759/cureus.7821