Interfragmentary screws through the plate fix the posterior column. Suprailioinguinal versus modified stoppa approach in the. Internal fixation of unstable pelvic ring injuries via the modified stoppa approach 31 connecting vessel between the obturator and femoral artery, was identified and ligated. Tshaped fracture with displacement predominantly in the posterior column or associated posterior wall fracture. Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. The modified stoppa, or anterior intrapelvic, approach to the acetabulum provides straightforward anatomic exposure that can be used for direct access to the pelvic brim, posterior column of the acetabulum, and the quadrilateral surface. The stoppa approach allows direct control of the anterior column around the acetabulum and it is often possible to control the reduction entirely at the level of the pelvic brim.
This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur the acetabulum is a cavity situated on the outer surface of the hip bone, also called the. The modified stoppa approach in the treatment of a t shaped acetabular fracture surgical video tech by omar al bardan only the paranoid survive 17. Modified stoppa approach for fractures of the acetabulum. Stoppa approach to acetabulum approaches orthobullets. Pdf the stoppa approach for acetabular fracture researchgate. Surgical treatment of displaced acetabular fractures using a. Approaches to the acetabulum no one surgical approach is applicable for all acetabulum fractures. Treatment of acetabulum fractures through the modified. Minimally invasive treatment of bothcolumn acetabular. Ota video library modified stoppa approach for fractures of. There is little information about the clinical anatomic specifications of exposure in the literature. A consecutive cohort of 60 patients from september 2014 to october 2017 with displaced acetabular fractures involving the quadrilateral plate were treated. Acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons.
In this paper we will present our experience in using the stoppa approach, its. Modified stoppa approach for surgical treatment of acetabular fracture article pdf available in clinics in orthopedic surgery 71. Internal fixation of unstable pelvic ring injuries via the. Bolhofner, acetabular fracture fixation via a modified stoppa limited intrapelvic approach. This video describes a step by step approach to perform the reduction and fixation of acetabular fractures from the front.
This may enable the lateral window to become unnecessary and the approach limited to the stoppa window only. We believe that the stoppa approach with an iliac window extension, previously described as a modified stoppa approach is adequate for the majority of acetabular fractures excluding those with predominant posterior wall involvement. Then, the pelvic ring was exposed subperiosteally from the pubic symphysis to the anterior aspect of. It is advantageous in treating acetabular fractures with anterior column involvement and even considered a superior alternative to ilioinguinal approach. Modified stoppa approach for fractures of the acetabulum cyril mauffrey, md on vimeo.
A consecutive cohort of 17 patients with displaced acetabular fractures treated operatively with use of only an anterior approach that combined the modified stoppa approach with the lateral window of the ilioinguinal approach. In this study, the pertinent surgical anatomy that involved the modified medial stoppa approach was further defined and the anatomic. The anterior intrapelvic approach or modified stoppa approach for the treatment of pelvic and acetabular fractures has been gaining popularity. The objective of this study was to determine whether the modified stoppa approach or the ilioinguinal approach is better for the treatment of acetabular fractures by comparing the results of those 2 approaches. The modified stoppa or aip approach to the acetabulum provides anatomic exposure that can be used for direct access to the pelvic brim, posterior column of the acetabulum, and the. Modified stoppa approach by cyril mauffrey youtube. The extrapelvic ilioinguinal il has been the workhorse for the anterior approach and remains the gold standard. The correct surgical approach is crucial for accurate reduction. Unreduced dome impaction can lead to degenerative arthritis and results in poor results.
Open reduction and internal fixation of acetabular. Report the technical aspects, radiographic results, and complications after minimum 1year follow up of the anterior intrapelvic aip or modified rives stoppa approach as an alternative to the ilioinguinal approach for the treatment of acetabular fractures. Acetabular fracture is a serious orthopedic injury that is managed using anterior, posterior, extensile, and combined surgical approaches. A surgical approach will be selected with the expectation that. Surgical treatment of displaced acetabular fractures using. Nine article were excluded which were regarding modified stoppa approach for acetabulum fractures but in language other than english. The anterior intrapelvic modified rivesstoppa approach. The intrapelvic modified stoppa approach is an important anterior exposure for acetabular trauma surgery. Introduction acetabular fractures are complex intraarticular fractures.
The application of the pelvic brim plate fixes the anterior column. In this study, the pertinent surgical anatomy that involved the modified medial stoppa approach was further defined and the. Pdf modified stoppa approach for surgical treatment of. Orif through modified stoppa approach for anterior column. This approach was combined with a lateral approach on the iliac crest for fractures of the iliac wing. Modified stoppas approach for acetabulum fractures. This intrapelvic approach is particularly useful for treating acetabular fractures with anterior column involvement and is by some considered to be a superior alternative to the more traditionally used. Ota video library modified stoppa approach for fractures of the acetabulum cyril mauffrey, md on vimeo. The third hospital of gansu province, lanzhou, china. Modified stoppa approach for acetabular fractures with. Modified stoppa approach in treatment of pelvic and. Treatment results for acetabulum fractures using the modified.
Hence, the modified stoppa approach msa can be adopted by a. The modified stoppa approach for acetabular fracture archdeacon, michael t. Ilioinguinal approach and the modified stoppa approach are commonly used anterior approaches. 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. In recent years, the modified stoppa approach for the operative treatment of acetabular fractures has gained significant popularity.
Herein, we present a case of operative reduction and fixation performed via the modified stoppa approach in acetabular fracture with superior dome impaction. Modified stoppa s approach for acetabulum fractures. The full text of this article is available in pdf format. The modified stoppa approach for acetabular fracture. Modified stoppa approach for operative treatment of. Aug 01, 2019 acetabular quadrilateral body fracture combined with central femoral head dislocation could be treated via the modified stoppa approach in a direct field of vision, which could significantly improve the quality of reduction, compared with the ilioinguinal approach. In 1994, cole and bolhofner began to use it successfully as minimally invasive acetabulum surgery in adult patients. Modified stoppa approach for fractures of the acetabulum vumedi. This video described the surgical technique and our 11 steps to perform a modified stoppa approach.
Modified stoppa, ilioinguinal, acetabulum fractures, acetabulum. Acetabular fracture fixation via a modified stoppa limited intrapelvic approach description of operative. Modified stoppa approach has been evaluated in many studies that reported similar clinical outcomes as the ilioinguinal approach 510. Home march 2011 volume 19 issue 3 the modified stoppa approach for acetabular fracture. Ota video library modified stoppa approach for fractures.
Orif through modified stoppa approach for transverse. The modified stoppa approach in the treatment of a tshaped acetabular fracture surgical video technique march 01, 2017 contributors. Introduction acetabular fractures are rare in childhood, because increased cartilage volume, joint elasticity, and strong ligaments in children allow for signi cantly higher energy absorption prior to fracture. Modified stoppa approach for surgical treatment of acetabular fracture. Open reduction and internal fixation of acetabular fractures. Sep 14, 2012 acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons. A randomized trial was undertaken of 60 consecutive patients with acetabular fractures treated with either the modified stoppa or the. The modified stoppa approach was introduced to manage fracture of the anterior column instead of the. Aug 14, 2017 modified stoppa approach for acetabular fractures with anterior and posterior column displacement. Department of orthopaedics, gansu provincial hospital of tcm, lanzhou, china. Jan 08, 20 the purpose of this prospective study is to compare hip adductor strength and obturator nerve palsy between acetabular fracture patients whose fracture was reduced and fixated using the modified stoppa approach subjects and pelvic fracture patients controls using physical strength testing, radiographs, clinical assessment, and a validated. The midline approach for hernia treatment with a complicated incision was first described by stoppa in 1989. The improved visualization provided by this approach facilitates fracture reduction and stabilization.
Quantification of radiographic reduction and analysis of interobserver variability. Fracture pattern, operative time, blood loss during the operation, quality of reduction, number of bony fragments in the acetabular weightbearing area, and postoperative. This modified stoppa approach affords excellent visualization of the pelvic ring, facilitating the development. Generally speaking, the modified stoppa approach can be adopted to treat all fractures that can be managed through the ilioinguinal approach. Anterior and posterior approaches have been described for fixation of acetabulum fractures. Acetabular fractures are one of the most difficult fractures to manage in orthopaedic surgery. The video that accompanies this article is the modified stoppa approach for fractures of the acetabulum, available on the orthopaedic. Modified stoppa approach for surgical treatment of acetabular. Use of the aip modified rives stoppa approach for the treatment of acetabular fractures permits good to excellent reduction in the majority of cases while giving excellent visualization and access to the quadrilateral plate and posterior column. This plate can be contoured to extend across the low exiting transverse fractures to the pubis, as required by the specific fracture. Modified stoppa approach for fractures of the acetabulum cyril mauffrey, md 4 years ago this video describes a step by step approach to perform the reduction and fixation of acetabular fractures. The stoppa approach for acetabular fracture springerlink. Acetabular fracture is an intraarticular fracture of the most important weight bearing joint, the hip joint, and in order to obtain optimal results, accurate anatomic.
Modified stoppa approach for surgical treatment of. May 27, 20 in the case presented herein, a modified stoppa technique approach with anterior column fracture fixation was used. Openreduction and internalfixation of acetabular fracturesusingthe modified stoppa approach january 23, 2019 volume 9, issue 1 e3 2. Modified stoppa approach is effective for fixing acetabular. The aip approach has a complication rate that is comparable to the ilioinguinal approach. Hip strength and nerve palsy after the modified stoppa.
Case report a modified stoppa technique approach for. Nov 14, 2019 to compare the efficacy of the operative techniques, complications, reduction quality and hip functional recovery by using the suprailioinguinal approach and the modified stoppa approach for the management of acetabular fractures. A contoured pelvic brim plate is used through the stoppa approach. We believe that the stoppa approach with an iliac window extension, previously described as a modified stoppa approach is adequate for the majority of acetabular fractures excluding those with. Some of the treatment was combined with the iliac fossa approach or rear kl approach. Modified stoppa approach for acetabular fracture clinics in orthopedic surgery vol. Acetabulum, acetabular fracture, stoppa approach acetabular fracture is an intraarticular fracture of the most important weightbearing joint, the hip joint, and in order to obtain optimal results, accurate anatomic reduction, firm fixation, and early rehabilitation are essential. The modified stoppa approach allows an adequate exposure and good postoperative results for treatment of pelvic ring fractures and acetabular fractures that are eligible for an anterior approach. The modified stoppa approach in the treatment of a t. Treatment of pelvic and acetabular fractures through modified stoppa port. The modified medial stoppa approach is an alternative and new surgical approach to access to the internal pelvis and medial wall of the acetabulum.
Article pdf available in clinics in orthopedic surgery 71. Newly modified stoppa approach for acetabular fractures. All of the 22 patients, who needed the anterior approach for the treatment of acetabular fractures at our hospital from november 2007 to november 2010, were subjected to surgery via the modified stoppa approach. Three cadaveric studies8, 9, 10 and two case reports11, 12 were excluded. From march 2010 to may 2012,16 patients with pelvic fractures and 7 patients with acetabutar fractures were treated by open reduction and internal fixation through the modified stoppa approach,involving 18 males and 5 females with an. Modified stoppa approach along with or without other approaches provides alternate to ilioinguinal approach for fixation of anterior acetabulum fractures, 30, 3235, 39 elmadag et al 33 concluded in their retrospective study of 36 patients that modified stoppa approach is a good alternative to ilioinguinal approach even for many complex. A modified stoppa technique approach for treatment of. Modified medial stoppa approach for acetabular fractures. The modified stoppa approach, which provided successful reduction of anterior column fractures and their components, including some complex acetabular fractures, is an alternative technique to the.
Acetabular fracture fixation via a modified stoppa limited i. Modified stoppa approach versus ilioinguinal approach for anterior. Fixation of pelvicacetabular fractures using a midline. Stoppa approach to the acetabulum for fractures vumedi. The modified stoppa approach is an intrapelvic approach initially used for inguinal hernia surgery by rives et al. Randomized, controlled trial of the modified stoppa versus. Fracture acetabulum is a grave injury and a challenge for orthopedic surgeons. They were followed up for at least 1 year postoperatively for radiographic and clinical assessments, which included the modified merle daubigne score, harris hip score, and pain visual analogue scale. To evaluate the modified stoppa approach in treatment of pelvic and acetabular fractures. Judet et al and letournel and judet laid the groundwork for the current understanding and management of acetabular fractures. The modified stoppa approach is considered an alternate to anterior approach, which provides access to pelvis from inside the cavity. Modified stoppa as an alternative surgical approach for.
The newly modified stoppa approach was performed to fix the acetabular fractures with main anterior displacement and the anterior and lateral parts of the pelvis. Anatomic reduction of these fracture is necessary to get the optimal. Orthopedics today the anterior intrapelvic approach or modified stoppa approach for the treatment of pelvic and acetabular fractures has been gaining popularity. Pdf the modified stoppa approach for acetabular fracture. The modified stoppa approach is considered an alternate to anterior approach, which. The stoppa approach is used in the repair of inguinal hernias. Internal fixation of acetabular fractures in an older population using the lateralrectus approach. Md jaaos journal of the american academy of orthopaedic surgeons.