Treatment results for acetabulum fractures using the modified Stoppa approach.

Acta Orthopaedica et Traumatologica Turcica 53 (2019) 6e14 Contents lists available at ScienceDirect Acta Orthopaedica et Traumatologica Turcica journal homepage: https://www.elsevier.com/locate/aott Treatment results for acetabulum fractures using the modified Stoppa approach Cem Yalin Kilinc a, Ahmet Emrah Acan a, *, Emre Gultac a, Rabia Mihriban Kilinc b, Onur Hapa c, Nevres Hurriyet Aydogan a a b c Department of Orthopedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey Department of Radiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey _ Department of Orthopedics and Traumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey a r t i c l e i n f o a b s t r a c t Article history: Received 10 July 2018 Received in revised form 3 October 2018 Accepted 28 November 2018 Available online 14 December 2018 Objectives: The aim of this study was to evaluate the clinical and radiological results of the surgical treatment of acetabular fractures using modified Stoppa approach. Methods: A total of 57 patients (mean age 37.8 years; range 15e84) who underwent surgical treatment for acetabular fracture with modified Stoppa approach from February 2013 to June 2016 were included into the study. The mean follow-up time was 28.1 months (range 24e35). The records were reviewed for fracture patterns, time to surgery, operative time, blood loss, reduction quality, and perioperative complications. Reduction quality was graded as anatomic, imperfect, or poor. The Harris Hip Score (HHS)  score were used for functional evaluation. and Merle d'Aubigne Results: Among the 63 acetabulum fractures of the 57 patients, 27 were associated with both columns, 12 were T-type fractures, 10 were transverse, 7 were anterior column/posterior hemitransverse, 5 were anterior column, and 2 were anterior wall fracture. A single surgeon performed all operations. Pfannenstiel incision was used in the first 19 cases while vertical midline incision in the remaining 38 cases. Average time to operation was 5.5 days, and supplemental lateral windows were used in 17 (29.8%) patients. Average blood loss and operation times were 660 mL and 152 min, respectively. Radiological outcomes were anatomic, imperfect, and poor in 52 (82.5%), 9 (14.2%), and 2 (3.2%) of the acetabulum  scores were mean fractures, respectively. Clinical outcomes at 2 years with HHS and Merle d’Aubigne 86.6 (range 66e96) (Excellent in 27, good in 23, fair in 4, poor in 3 patient) and 16.7 (range 10e18) (Excellent in 25, very good in 18, good in 6, fair in 5, poor in 3 patient), respectively. There was a significant relation between the reduction quality and clinical outcome (p < 0.001), while there was no significant relation between the clinical outcome and the fracture type (p > 0.05). Iatrogenic external iliac vein damage was noted in 2 patients. Obturator nerve palsy was noted in 3 patients, who recovered spontaneously at mean time of 3.7 months (range 3e5). Rectus abdominus paralysis was noted in 2 of the 19 (10.5%) Pfannenstiel-incision patients but not in the vertical-incision patients. Conclusion: Our experience in 57 patients shows that satisfactory results can be obtained, even in bilateral fractures with vertical midline incision. Level of evidence: Level IV Therapeutic Study © 2018 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/). Keywords: Acetabulum Stoppa Modified Pelvic Fracture Result Introduction * Corresponding author. Tel.: þ902522115228. Fax: þ902522141326. E-mail addresses: (C.Y. Kilinc), (A.E. Acan), (E. Gultac), (R.M. Kilinc), (O. Hapa), (N.H. Aydogan). Peer review under responsibility of Turkish Association of Orthopaedics and Traumatology. The basic aim of the various surgical approaches used in fractures of the acetabulum is to be able to provide anatomic reduction with minimum complications,1,2 since morbidity is high in cases of inappropriate reduction.3 The poor clinical outcome of nonanatomic reduction will eventually require total hip arthroplasty.1 https://doi.org/10.1016/j.aott.2018.11.003 1017-995X/© 2018 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). C.Y. Kilinc et al. / Acta Orthopaedica et Traumatologica Turcica 53 (2019) 6e14 Different surgical approaches can be used for acetabular fractures, including the Kocher-Langenbeck, iliofemoral, ilioinguinal, combined anterior/posterior, extended iliofemoral, transtrochanteric, modified Stoppa, and triradiate approaches.4e11 These approaches can be classified as anterior, posterior, extensile, or combined approaches. In choosing the approach to be made, the fracture configuration, the experience of the surgeon and the soft tissue conditions such as Morel-Lavallee lesions are important considerations.12 Of these approaches, the modified Stoppa technique, which Cole and Bolhofner presented in 1994, has begun to be used more widely in recent years.13 The modified Stoppa approach has many advantages: it provides a sufficient area of visualisation for pelvic ring exposure, does not involve iliac artery vein or femoral nerve exposure, provides sufficient reduction in anterior wall and column fractures, and can be used when an anterior fracture exists together with a posterior hemitransverse fracture, in addition to fractures of both columns.14 Moreover, the application of a plate to the quadrilateral surface is feasible in the Stoppa approach, and this facilitates anatomic reduction.15,16 In addition to anatomic reduction, decreased intraoperative blood loss and shorter operating times have been reported with the modified Stoppa approach.15e17 The aim of this study is to demonstrate the effectiveness of the modified Stoppa approach in treating fractures of the acetabulum by evaluating the postoperative radiological and clinical results of patients who had a minimum 24-month follow-up, and then to compare the results to those from other studies in the literature that have used the modified Stoppa technique. Patients and methods Approval for this study was granted by the local ethics committee. A retrospective evaluation was conducted of patients who had undergone the modified Stoppa technique for an acetabular fracture at a medical faculty hospital between February 2013 and June 2016, with a minimum 24-month follow-up period. Demographic data, mechanism of trauma, associated injuries, Injury Severity Score (ISS), time to surgery, surgery time, intraoperative bleeding, and intraoperative or perioperative complications were obtained from the patients' medical records. The indications for surgery were an unstable fracture in the weight-bearing region, a displacement of 2 mm in the non-weig (...truncated)