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Objective: To compare surgical outcomes of acute acetabular transverse fracture using ilioinguinal and Stoppa approach. Methods: Twenty five patients who managed with ilioinguinal approach (group A) at a mean follow-up of (32.3±4.6) mo and 30 patients who managed with Stoppa approach (group B) at a mean follow-up of (29.7±3.8) mo were prospectively...
Context in source publication
Context 1
... value 12.55 P value 0.073 Reduction quality was measured by Matta radiological grading including unsatisfactory, satisfactory and anatomical. Chi square test was applied to analyzed data, and there was no significant differences between two groups ( Table 2). The postoperative radiographic reduction quality was also shown in Figure 1 and Radiological results at the end of follow-up was shown in Table 3. Chi square test was applied to analyzed the data and there was no significant differences between two groups. ...
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Citations
... Three of the ten included studies [16,26,27] were RCTs in design while the remaining seven were retrospective [13-15, 25, 28-30]. A total of 717 acetabulum fractures were included in the current review. ...
... There were seven non-randomized comparative studies [13-15, 25, 28-30] while three were RCT studies [16,26,27]. MINORS tool Score was ≥ 17 for 6/7 non-randomized studies [14,15,25,[28][29][30]. ...
... The mean duration of surgeries was reported in 9/10 studies [13,15,16,[25][26][27][28][29][30]. Mean duration of surgery ranged from 134.4 to 293.4 min for ilioinguinal and 107.14-240.5 min for the modified Stoppa approach. ...
Background
Acetabulum fracture is one of the most challenging fractures to manage and operate for orthopaedic surgeons; anatomical reduction of fractures and reconstruction of the joint is of utmost importance. These factors in turn are dependent on the appropriate surgical approach used to improve the clinical outcomes and reduce associated complications. Hence, this meta-analysis aims to compare the outcomes of ilioinguinal versus modified Stoppa approach for open reduction and internal fixation (ORIF) of displaced acetabular fractures.
Methods
Medline (PubMed), Embase, Scopus, and Cochrane Library databases were searched from their inception to 10th of June 2021 for both randomized clinical trials (RCTs) and or non-randomized studies comparing the outcomes of ilioinguinal approach and modified Stoppa approach for the ORIF of acetabular fractures. The estimates of treatment effects were described by mean difference (MD) for continuous variables and odds ratio (OR) for dichotomous variables with corresponding 95% confidence (95% CI) intervals. The risk of bias was assessed by MINORS tool for the non-randomized, and the Cochrane Collaboration’s risk of bias tool for RCTs.
Result
A total of ten studies (717 patients), three RCTs and seven retrospective studies, were included. Modified Stoppa approach showed shorter mean duration of surgery (MD 47.13, 95% CI: 27.30–66.96), lesser number of overall complications (OR 2.14, 95% CI: 1.46–3.13), less intraoperative blood loss (MD 259.65, 95% CI: 152.66–366.64), and lower rates of infection (OR 2.17, 95% CI: 1.14–4.15). However, ilioinguinal approach showed a better quality of fracture reduction (OR 0.59, 95% CI: 0.42–0.82). Results were equivocal in terms of vascular injuries (OR 1.88 (95% CI: 0.86–4.09), nerve injuries (OR 1.77, 95% CI: 0.99–3.17), heterotopic ossification (OR1.74, 95% CI: 0.63–4.82), and clinical outcome (OR 0.81, 95% CI: 0.45–1.47) between the two groups.
Conclusion
Modified Stoppa approach carries a lesser duration of surgery, lesser intraoperative blood loss, fewer overall complications, and lesser postoperative infection rates compared to ilioinguinal approach. Although a better anatomical reduction is achieved by ilioinguinal approach, however, this does not translate into better clinic functional outcomes which remain comparable between the two approaches. So overall, modified Stoppa approach seems a better alternative for managing these fractures.
: Acetabular fractures are commonly caused by high-velocity injuries that can result from falls from heights or motor vehicle accidents. Surgical fixation has been found to result in improved clinical outcomes such as reduced pain, improved range of motion, and improved alignment and stability of the joint. Patients with pelvic injuries often have associated multiple systemic injuries, adding to the overall morbidity and mortality. Treating fractures in the pelvic area involving the acetabulum can be complicated, significantly when displaced. Proper exposure of the acetabulum and rigid internal fixation is necessary to achieve the main goals of treatment, which are to reconstruct the articular surface and promote early mobilization. Closed methods make it nearly impossible to restore the articular surfaces completely and obtain enough stability for early hip motion.
: This study assesses the functional outcome of open surgical fixation of acetabulum fractures involving single or both columns.
: Our study looked at patients over 18 years old with displaced fractures, and we treated them using only two approaches: the Kocher Langenbeck approach and the Modified Stoppa approach. Radiological and functional examinations were performed monthly for the first six months. Postoperative radiological assessments were graded using Matta's criteria, and functional outcomes were assessed using modified Merle d' Aubigné and Postel Hip Score.
: We treated displaced acetabular fractures using only two non-extensile approaches: the Kocher Langenbeck approach and the Modified Stoppa approach. In most cases (67%), we used only one method, except in 7 patients. Our treatment achieved an impressive 85% rate of good to excellent outcomes (18 out of 21). Our study found that the delay in surgery time significantly impacted Merle d' Aubigne scores (P<0.05), leading to complications and lower functional outcomes in complicated cases. The functional and radiological outcomes were also significantly affected by the mechanism of injury, time between injury and surgery, initial degree of displacement, and quality of reduction. Surgical fixation of displaced acetabular fractures can yield better results with good imaging facilities, experienced surgeons, better instrumentation, and good perioperative care. However, further studies with an adequate sample size are needed to validate our findings.
A study on the outcome of acetabular fractures treated surgically found that early surgical intervention and good perioperative care can lead to satisfactory functional outcomes. The study used only two non-extensile approaches and achieved an 85% rate of suitable to excellent outcomes. The study also observed that the mechanism of injury, time between injury and surgery, initial degree of displacement, and reduction quality significantly affected functional and radiological outcomes. However, further studies are needed to validate the findings.
Achieving an anatomically precise reduction of acetabular fractures is vital for obtaining the best possible outcome. The Modified Stoppa approach has demonstrated advantages such as reduced blood loss and shorter surgical durations when dealing with anterior acetabular fractures in comparison to the ilioinguinal approach. Objective: To evaluate the outcomes of the modified Stoppa approach in comparison to the ilioinguinal approach. Methods: The quasi-experimental study was conducted within the Department of Orthopaedic Surgery at Jinnah Hospital during the period from November 12, 2018, to May 11, 2019.The study involved 60 patients, with 30 individuals in each group. Group A underwent treatment for anterior acetabular fractures using the modified Stoppa method, while Group B received treatment using the ilioinguinal approach. Results: Patients ranged between 16-60 years of age with mean age of 36.9±11.2 in group-A and 35.6±10.3 year in group-B. Majority of the patients were male in both groups. Left anatomical side was involved in most of the patients in both groups. The mean duration of injury in group-A was 7.07±2.6, while in group-B, it was 6.6±2.4. A statistical analysis revealed a significant difference between the two groups in terms of mean operative time and blood loss (p<0.001). Furthermore, stratification was performed based on age, gender, and the duration of injury, and significant differences were observed in these stratified subgroups as well. Conclusions: Our findings showed that modified Stoppa technique outperforms the ilioinguinal method by exhibiting reduced blood loss and shorter operative durations. This positions the modified Stoppa technique as a superior option for addressing anterior acetabular fractures.
