Treatment results for acetabulum fractures using the modified Stoppa approach

Stoppa Intrapelvic Approach Provides Good Functional Clinical Outcomes: Prospective Study with a Minimum Follow-up of One Year and Comparison with the Literature

Objective  To describe the clinical and radiographic outcomes of a cohort of patients with acetabular fractures treated with the modified Stoppa approach. Methods  We conducted a prospective analysis of adult patients with acetabular fractures treated using the modified Stoppa approach from June 2020 to June 2021, with a minimum follow-up period of 12 months. The analysis included demographic, epidemiological, and perioperative data, as well as postoperative radiographic and functional outcomes. Results  The study included 15 cases, with 14 men (93.3%) and 1 woman (6.67%). A postoperative tomographic evaluation revealed an anatomical reduction in 50%, an imperfect reduction in 13.6%, and a poor reduction in 36.4% of the subjects. Regarding the functional scores, the Harris Hip Score ranged from 56 to 100, with a mean value of 92.5. The Majeed Pelvic Score classified the functional outcome as excellent in 36.5%, good in 40.6%, moderate in 18.7%, and poor in 4.2% of the cases. Conclusion  The present case series study demonstrated positive statistical relevance between reduction quality and functional outcomes and between the time until surgery and the reduction quality. The functional outcomes at a one-year of follow-up demonstrate that this approach can be an excellent alternative for anterior acetabulum fractures.

Comparison of 2 different fixation techniques of comminuted acetabular quadrilateral surface fractures using square bracket-shaped tubular plate or interfragmentary screws in addition to supra/infrapectineal plate fixation: An observational study

The management of comminuted quadrilateral fractures remains challenging, and treatment options are constantly evolving. The purpose of the present study was to examine the outcomes of 2 different fixation techniques in the management of comminuted quadrilateral fractures. Twenty-two patients with comminuted quadrilateral acetabular fractures were surgically treated with interfragmentary lag screw (group 1) and square bracket-shaped tubular (SBST) plate technique (group 2), in addition to suprapectineal and infrapectineal pelvic reconstruction plate fixation between January 2016 and July 2019 at our clinic. 2 years follow-up control data of each group were compared in terms of radiological and functional results, and complications. According to the functional score comparison, the mean Merle d'Aubigne Postel scoring system (MAP) score was 15.2/15.6 (P = .632), and the mean Harris hip scoring (HHS) system score was 74.65/77.3 (P = .664) in groups 1 and 2, respectively. Radiological comparison was performed according to matta radiological criteria (MRC), and 2 excellent, 6 good, 2 poor, 4 excellent, 4 good, and 4 poor radiological results were observed in groups 1 and 2, respectively. intraarticular screw penetration was detected in 3 patients in group 1, while there was no articular implant penetration in group 2 (P = .001). We believe that satisfactory results can be obtained with the SBST plate technique, offering functional and clinical outcomes that are similar to those of the interfragmentary screw technique. The SBST plate technique is superior in terms of avoiding intraarticular screw penetration and related revision surgery.

Vertical Versus Pfannenstiel Incision-Modified Stoppa Approach in the Treatment of Acetabular Fractures

OBJECTIVES

The aims of this study were to compare the patient and fracture characteristics, radiological, functional, and quality of life outcomes; the need for a lateral window approach and requirement of total hip arthroplasty; and complications in patients with simple and complex acetabular fractures who underwent a modified Stoppa approach through vertical and Pfannenstiel incisions.

METHODS

DESIGN

This was a retrospective comparison study.

SETTING

Level 1 trauma center.

PATIENT SELECTION CRITERIA

Patients with acetabular fractures (A-O-/-O-T-A type 62A-B-C) treated with vertical (group V) or Pfannenstiel (group P) incision-modified Stoppa approach between 2010 and 2020 were included.

OUTCOME MEASURES AND COMPARISONS

Patient characteristics, radiological evaluations (reduction quality and posttraumatic osteoarthritis), patient functional outcomes [12-item Short-Form Survey (SF-12) physical component score, SF-12 mental component score, Harris Hip Score, and Merle d'Aubigné-Postel], approach modifications and stratification by fracture type and complications were compared between those treated with vertical or Pfannenstiel incisions.

RESULTS

One hundred four patients (mean age of 38.5 ± 14.3 years) were included. There was no significant difference between the Pfannenstiel or vertical groups regarding patient and fracture characteristics (P = 0.137), postoperative reduction quality (P = 0.130), or the mean functional and quality of life outcome scores at the last follow-up (P = 0.483 for the Harris Hip Score, P = 0.717 for the Merle d'Aubigné-Postel score, P = 0.682 for the SF-12 physical component score, and P = 0.781 for the SF-12 mental component score). In group P, significantly more patients needed additional lateral incisions (40.8% vs. 10.9%; P 0.001) and total hip replacement procedures (12.2% vs. 1.8%; P = 0.049). The total, early, and late complication rates were significantly higher in group P (P 0.001, P = 0.034, and P = 0.049, respectively).

CONCLUSIONS

Pfannenstiel incision was associated with higher complication rates than vertical incision in acetabular fractures treated through a modified Stoppa approach. Fracture complexity is associated with the need for a lateral window approach and total hip arthroplasty, as well as a worse functional and radiological outcome regardless of incision type. However, it was not associated with the development of intraoperative or postoperative complications.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical and Radiological Outcomes of Patients With Anterior Acetabulum Fractures Treated by the Modified Stoppa Approach

Introduction Acetabular fractures are intra-articular fractures involving the lower extremity's weight-bearing dome. These fractures require an anatomical reduction of the fracture fragments. This aim can be accomplished by the selection of an appropriate surgical approach. This study aimed to analyze the clinical and radiological outcomes of patients with fractures in the anterior part of the acetabulum who were treated by the modified Stoppa approach. Methods This prospective observational study was conducted from April 2022 to September 2023. The inclusion criteria were: (i) age between 18 and 70 years, (ii) displaced acetabular fracture (displacement > 3 mm), (iii) within three weeks of trauma (iv) acetabular fractures with involvement of anterior column. Exclusion criteria included: (i) patients with visceral injuries requiring colostomy, (ii) pathological fracture, (iii) open fractures of the acetabulum, and (iv) neglected fracture (more than three weeks). Intraoperative data regarding surgical time, amount of blood loss, and incidence of intraoperative complications were recorded. In the postoperative period, anteroposterior X-ray and Judet views of the pelvis X-ray were obtained. Matta criteria were used to judge the quality of Fracture reduction and fixation. All the patients to be included in this study had undergone a minimum follow-up duration of six months. At the last follow-up, an assessment of the functional outcome of the affected hip by Merle d'Aubigné Hip Score and Harris Hip Score was done. Results Twenty-four patients were included in the study. The mean patient age was 36.08±11.65 years. Eighteen patients were male (75%) and six patients were female in this study. All acetabular fractures were due to high-energy trauma: road traffic accidents in 22 cases (91%) and fall from height in two cases (9%). According to Judet & Letournel's classification, there were 13 T-type fractures, five transverse fractures, and six associated both column fractures. The mean duration of surgery was 152.08 ±29.19 minutes, and the mean intraoperative blood loss was 277.08±85.95 ml. Intraoperatively one unit of blood transfusion was done in most cases. There were intraoperative complications of rent in the external iliac vein in two patients. Postoperative X-rays showed anatomical reduction in 17 cases, imperfect reduction in five cases, and poor reduction in two cases. Functional outcome of the hip by Merle d'Aubigné Hip Score was very good in 15, good in four, fair in three, and poor in two patients. Similar functional outcomes were obtained with the Harris Hip Score. Conclusion The results of the current study demonstrated that the modified Stoppa approach allows good visualization of the pelvic brim, quadrilateral surface, and posterior column. Lesser experienced orthopedic surgeons should utilize this approach to get good radiological and functional outcomes.

Treatment of Acetabulum Anterior Wall Fractures Using the Modified Stoppa Approach

Introduction The objective of this study was to describe the modified Stoppa approach for anterior wall fracture fixation and to present our radiological and functional results of this approach. Materials and methods Between April 2013 and December 2019, 256 acetabular fractures operated with the modified Stoppa approach in our clinic were retrospectively reviewed, and 11 patients who were operated for anterior acetabular wall fractures with at least two years of follow-up were included in the study. Results The median amount of bleeding during surgery was found to be 450 ml (200-800), and the median operation time was 120 minutes (90-180). The modified Merle d'Aubigné and Postel Hip Score (MDS), modified Harris Hip Score (HHS), Matta's Reduction Criteria (MRC), and Kellgren-Lawrence Classification (KLC) outcomes are similar to the anterior surgical approach. Conclusion We suggest that the modified Stoppa approach can be safely used in the surgical treatment of isolated anterior acetabular fractures due to its short operative duration, low amount of bleeding, low complication rate, and favorable radiological and clinical results. The modified Stoppa procedure is a considerable alternative to the ilioinguinal approach in anterior acetabular fractures.

Morphometric measurements for potential dangers of anterior intra-pelvic approach in women: A cadaveric study

OBJECTIVE

This study aimed to improve the surgical anatomical knowledge of pelvic/acetabular trauma surgeons by providing detailed morphometric data on some of the most vulnerable arteries and nerves due to constant bony landmarks during anterior intra-pelvic approach fixation of acetabular fractures in women.

METHODS

Ten hemipelvis were dissected from 5 female cadavers. The following measurements relative to the symphysis were performed: (1) the distance of the corona mortis anastomosis and (2) the bisection of the external iliac vein with the pubic ramus. In addition, dis- tance to the pelvic brim at the level of pectineal convexity of the following structures was measured: (3) depth of obturatory neurovascu- lar bundle, (4) superior vesical artery, and (5) vaginal artery. Also, the clock position of the (6) gluteal superior and inferior vessels due to sciatic notch in the supine position. Due to antero-superior corner of sacroiliac joint (7) location of the common iliac artery bifurcation, (8) location of the bifurcation of internal iliac vessels to truncuses, (9) bifurcation of superior gluteal artery and lateral sacral artery, and (10) L5 nerve were measured. The descriptive statistics were given as medians and ranges as this is a descriptive anatomical study without comparisons.

RESULTS

The median distance of corona mortis to symphysis pubis was 59.5 mm (range = 58-61). The external iliac vein bisected the pubic arm 68.5 mm (range=65-70) lateral to the symphysis pubis. At the level of pectineal convexity (about the middle of the pelvic brim), obturatory neurovascular bundle, superior vesical artery, and vaginal artery were 15 mm (range=13-16), 24 mm (range=23-25), and 36 mm (range=34-38) inferior to the pelvic brim, respectively. The superior gluteal vessels leave the sciatic notch at 12 o'clock position in supine position. Inferior gluteal vessels leave the sciatic notch at 31⁄2 o'clock position (given for left side). Common iliac artery bifurcation bisects the SI joint 5 mm (4-7) superior to antero-superior corner of the Sacro-iliac (SI) joint. The internal iliac artery gives its posterior trunk 18 mm (range=15-20) straightly anterior to antero-superior corner of the SI joint. Bifurcation of superior gluteal artery and lateral sacral artery was 11 mm (range = 10-12) away from the beginning of the posterior truncus. L5 root's medial margin was 9 mm (range = 7-10) medial to this landmark, where its lateral margin was on the SI joint (2 mm medial to 2 mm lateral).

CONCLUSION

The majority of the bleeding complications of the major branches of the internal and external iliac arteries and neurologic palsies due to obturatory nerve and L5 nerve root damage within the operative field of the anterior intra-pelvic approach can be avoided or managed by utilizing morphometric data provided from this study.

LEVEL OF EVIDENCE

N/A.

Drain vs. no-drain for acetabular fractures after treatment via a modified stoppa approach: A retrospective study

Objective

The aim of this study was to compare the clinical efficacy of close suction drainage (CSD) and no-CSD after a modified Stoppa approach for the surgical fixation of acetabular fractures.

Methods

This retrospective study included 49 consecutive acetabular fracture patients, who presented to a single level I trauma center for surgical fixation, using a modified Stoppa approach from January 2018 to January 2021. All surgeries were performed by a senior surgeon using the same approach, and the patients were divided into two groups based on whether CSD was used after the operation. Details of the patient demographics, fracture characteristics, intraoperative indicators, reduction quality, intra and postoperative blood transfusion, clinical outcomes, and incision-related complications were collected.

Results

No significant differences were found in the demographics, fracture characteristics, intraoperative indicators, reduction quality, clinical outcomes, and incision-related complications between the two groups (P > 0.05). The use of CSD was associated with a significantly higher postoperative blood transfusion volume (P = 0.034) and postoperative blood transfusion rate (P = 0.027). In addition, there was a significant difference in postoperative temperatures, especially on postoperative Day 2 (no-CSD 36.97 ± 0.51°C vs. CSD 37.34 ± 0.69°C, P = 0.035), and higher visual analogue scale (VAS) scores, especially on postoperative Day 1 (no-CSD 3.00 ± 0.93 vs. CSD 4.14 ± 1.43, P = 0.002) and 3 (no-CSD 1.73 ± 0.94 vs. CSD 2.48 ± 1.08, P = 0.013).

Conclusion

The results of this study suggest that routine use of CSD should not be recommended for patients with acetabular fractures after surgical fixation using a modified Stoppa approach.

Fixation of bilateral acetabular fractures using the modified Stoppa approach: Two-year clinical outcomes

OBJECTIVES

This study aims to evaluate the two-year clinical results of bilateral acetabular fractures operated via a single incision with the modified Stoppa approach.

PATIENTS AND METHODS

Between January 2013 and January 2020, a total of 22 acetabular fractures of 11 patients (7 males, 4 females; mean age: was 42.9±13.7 years; range, 19 to 62 years) who were operated via the modified Stoppa approach were retrospectively analyzed. The medical records were analyzed in terms of time to surgery, fracture patterns, Injury Severity Score (ISS), operation duration, blood loss, reduction quality, perioperative complications and concomitant injuries. Reduction quality was assessed according to Matta's criteria. The Harris Hip Score (HHS) and modified Merle d'Aubigne score (MDS) were utilized for functional assessment.

RESULTS

The mean follow-up was 49±15 (range, 30 to 79) months. The mean ISS was 28.2±7.2. The mean modified MDS was 15.90±1.57. The mean HHS was 84.27±8.85. For both sides, reduction was anatomical-anatomical (63.6%) in seven patients, anatomical-imperfect in three (27.3%) patients, and imperfectpoor in one (9.1%) patient. According to the Kellgren-Lawrence radiological evaluation at 24 months of follow-up bilaterally, Grade 0-1 osteoarthritis was observed in six (54.5%) patients, Grade 1-1 in four (36.4%) patients, and Grade 1-2 osteoarthritis in one (9.1%) patient.

CONCLUSION

The modified Stoppa approach in bilateral acetabular fractures seems to be more preferable than other approaches, as it can be performed with a single incision and provides less bleeding, shorter operation duration, and satisfactory results.

Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

BACKGROUND

Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown.

MATERIALS AND METHODS

A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes.

RESULTS

Thirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13-84) and mean follow-up was 19.8 months (range 1.5-56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%).

CONCLUSIONS

Bilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.

Clinico-Radiological Evaluation of Modified Stoppa Approach in Treatment of Acetabulum Fractures

Background

The aim of our study was to evaluate the efficacy of Modified Stoppa approach for surgical treatment of acetabulum fractures by analyzing clinical and radiological outcomes. Also, we assess intraoperative and postoperative complications of fracture treated by using Modified Stoppa approach.

Objectives

To evaluate clinical outcomes of Modified Stoppa approach by using Merle d'Aubigne hip score. To evaluate the radiological reduction quality of Modified Stoppa approach by using the criteria of Matta, and to assess complications of Modified Stoppa approach. 

Method

Thirty-two patients participated in this study (mean age 40 years; range 18-60 years) and the male to female ratio was 4:1, patients who underwent surgical intervention for acetabular fracture by using Modified Stoppa approach from Oct 2017 to April 2019 were included. Out of 32 patients, two were lost in follow up, leaving 30 of 32 patients for clinico-radiological analysis. We classified the fracture pattern according to Judet and Letournel classification based on preoperative X-ray AP view, Judet View, and 3D-CT pelvis. Operative time, blood loss, reduction quality, and perioperative complications were assessed in each patient. Clinical outcomes were assessed by Merle d’Aubigne hip score and radiological outcomes by criteria of Matta. 

Results

Out of 30 acetabulum fractures in 30 patients, three (10%) were categorized as anterior column fracture, one (3.3%) as transverse with posterior wall, one (3.33%) as T-type, six (20%) as anterior column with posterior hemi-transverse and 19 (63.33%) as both column fractures. In our study, most patients have trauma due to road traffic accident (RTA) in 25 (83.3%) and fall from stairs in three (10%) patients. Timing of surgery after trauma was average 5.83 days (range three to 15 days), Mean surgical time determined to be 214.66 min (range 150-350 min) and mean intraoperative loss 683.33 ml (range 230-1250 ml). Clinical outcomes by Merle d’Aubigne hip score was excellent in 13 (43.33%), good in 15 (50%), fair in two (6.66%) patients whereas poor results in 0 (0%) patient (p=0.001). Quality of reduction by Matta criteria was found to be an anatomical reduction in 26 (86.6%), imperfect reduction in three (10%), and poor reduction in one patient (3.33%) (p<0.001). Radiological grading by Matta criteria was excellent in 24 (80%), good in five (16.66%), and fair in one (3.33%) patient, and no patients met criteria for poor results (p<0.001). In operative complications one patient developed an external iliac vein injury which was repaired by a vascular surgeon, one patient had a superficial infection for which debridement, regular dressing, and IV antibiotics given and resolve in one month, obturator nerve injury in one patient which was resolve in five to six months, lateral femoral cutaneous nerve injury in one patient which resolved within three months and one patient urinary bladder injury which was repaired by a general surgeon. 

Conclusion

Our experience with Modified Stoppa approach for surgical treatment of acetabulum fracture in 30 patients is excellent and effective for better visualization to anterior column, quadrilateral plate, and up to sacroiliac joint. This approach provides better visibility of the fracture site which allows for good to an excellent reduction of fracture and fixation. Although Stoppa approach is cosmetic surgery in terms of scar size, there is less complication rate than the ilioinguinal approach. 

A retrospective comparison of the conventional versus three-dimensional printed model-assisted surgery in the treatment of acetabular fractures

OBJECTIVE

The aim of this study was to compare the clinical and radiological outcomes of the conventional versus individualized three-dimensional (3D) printing model-assisted pre-contoured plate fixation in the treatment of patients with acetabular fractures.

METHODS

The data from 18 consecutive patients who underwent surgery for the acetabular fractures were retrospectively analyzed. The patients were divided into two groups (9 in each): conventional and 3D printed model-assisted. The groups were then compared in terms of the duration of surgery, time of instrumentation, time of intraoperative fluoroscopy, and volume of blood loss. The quality of the fracture reduction was also evaluated postoperatively by radiography and computed tomography in both the groups. The quality of the fracture reduction was defined as good (<2 mm) or fair (>2 mm) based on the amount of displacement in the acetabulum.

RESULTS

The conventional group included 9 patients (9 males; mean age=41.7 years; age range=16-70) with a mean follow-up of 11.9 months (range=8-15); the 3D printed model-assisted group consisted of 9 patients (9 males; mean age=46.2 years; age range=30-66) with a mean follow-up of 10.33 months (range=7-17). The average duration of surgery, mean time of instrumentation, time of intraoperative fluoroscopy, and mean volume of blood loss were 180.5±9 minutes, 36.2±3.6 minutes, 6±1 times, and 403.3±52.7 mL in the 3D printed model-assisted group, and 220±15.6 minutes, 57.4±10.65 minutes, 10.4±2.2 times, and 606.6±52.7 mL in the conventional group, respectively. Procedurally, the average duration of surgery, mean time of instrumentation, and mean time of fluoroscopy were significantly shorter, and the mean volume of blood loss was significantly lower in the 3D printed model-assisted group (p<0.05). The quality of the fracture reduction was good in 7 patients (78%) in the conventional group and 8 patients (89%) in the 3D printed model-assisted group.

CONCLUSION

As compared with the conventional surgery, the 3D printing model-assisted pre-contoured plate fixation technique can improve the clinical and radiological outcomes of the acetabular fractures, with shorter surgery, instrumentation, intraoperative fluoroscopy times, and blood loss.

LEVEL OF EVIDENCE

Level III, Therapeutic study.

Prospective Evaluation of Outcome of Acetabular Fractures Managed by Anterior Intrapelvic Approach

INTRODUCTION

Anterior Intrapelvic (AIP) approach has emerged, in the last two decades, as a promising approach for fixation of anterior acetabular fractures. This prospective study was conducted to analyze our results with this approach and suggest the indications for its rationale usages in a developing country.

MATERIALS AND METHODS

All patients with acetabular fractures, which required anterior fixation, were operated by AIP approach and prospectively evaluated between October 2013 and January 2018. Mechanism of injury, fracture type, operative time, blood loss, complications, radiographic, and functional outcomes were analyzed in all patients. Modified Merle D'Aubigne system was used for clinical grading, while Matta's grading was utilized for radiographic outcome.

RESULTS

Fifty eight [90.62%] patients out of the total 64 patients had good to excellent outcome on functional and radiographic results. About 93.75% patients were able to resume pre-injury activities including socially demanding tasks like ability to sit cross legged and squat. Patients operated early had better articular reductions as compared to those operated late.

CONCLUSIONS

This approach can be considered as a safe, effective and feasible alternative to traditional ilioinguinal approach for acetabulum fractures which require anterior approach. Cases which present late may have difficulty through this approach as scarring or granulation tissue may lead to inadequate visualization.

Single Ilioinguinal Approach to Treat Complex Acetabular Fractures with Quadrilateral Plate Involvement: Outcomes Using a Novel Dynamic Anterior Plate-Screw System

Objectives

To evaluate the efficacy and safety of a novel fixation technique referred to as the dynamic anterior plate–screw system for quadrilateral plate (DAPSQ) for complex acetabular fractures with quadrilateral plate involvement through the single ilioinguinal approach.

Methods

A total of 32 patients with acetabular fractures, selected between January 2009 and March 2016, were managed by DAPSQ with “quadrilateral screws” through single ilioinguinal approach. The primary outcomes measure was the reduction quality evaluated according to the Matta radiological criteria, and the functional outcomes were evaluated by the modified Merle d'Aubigné score at the last follow‐up. Secondary outcomes were postoperative complications and intraoperative conditions included, for instance, operation time and blood loss.

Results

Of these 32 consecutive patients, 19, 9, and 4 were classified as both columns, anterior column posterior hemi‐transverse, and T‐shaped fractures, respectively, and with an average of 47 months’ follow‐up. Anatomic reduction was obtained in 19 cases (59%), imperfect reduction in 9 cases (28%), and poor reduction in 4 cases (13%). The modified Merle d'Aubigné scores were excellent in 15 cases (47%), good in 13 cases (41%), fair in 2 cases (6%), and poor in 2 cases (6%). Three cases sustained temporary lateral femoral cutaneous nerve injuries. One patient had a superficial wound infection that resolved after debridement. Five patients had posttraumatic arthritis; one of them underwent total hip arthroplasty at 46 months. No cases had quadrilateral screws entering the hip joint.

Conclusion

The use of DAPSQ with quadrilateral screws is an effective and safe choice for complex acetabular fractures with quadrilateral plate involvement through the single ilioinguinal approach.

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

BACKGROUND

As the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures.

METHODS

Twenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d'Aubigne and Postel score with a mean follow up of 15.13 months.

RESULTS

The clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively.

CONCLUSIONS

Minimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.