Modified Stoppa Approach for Acetabular Fixation

Abstract

Introduction: When acetabular fractures are intra-articular, correct anatomic reduction is important to achieve an excellent functional outcome. A few of the surgical techniques like ilioinguinal and modified Stoppa techniques are the only available intra-pelvic procedures. Despite the fact that ilioinguinal method is more commonly used, modified Stoppa technique is becoming more popular due to the possibility of visualizing and reducing quadrilateral plate fragments in addition to fixation of posterior column through anterior approach. The goal of our study is to assess the efficacy of various reduction tools/ techniques for reduction and fixation of fractures by use of modified Stoppa technique. Materials and Methods: We have operated on 16 patients with acetabular fractures through modified Stoppa approach within the age group of 19 years to 70 years (mean 42 years) with male female ratio of 13:3. In patients requiring combined method, the anterior approach was performed first. In most of the patient’s, modified Stoppa was combined with a lateral window. we have used various reduction strategies consisting of trans trochanteric Schanze pin, intra-focal elevators, ball spike, bone hook, iliac crest Schanze pin, Farebeat forceps, under contoured plate and many others. Results: Matta’s radiographic reduction criteria showed anatomic reduction in 10 cases. Clinical evaluation using Merle d’ Aubigne scoring showed excellent outcomes in 9 cases and good results in 6 cases. Follow up was done for a most duration of six months. Conclusion: Modified Stoppa technique provides better visualisation of quadrilateral floor and sciatic buttress while compared to the ilioinguinal method. Using suitable reduction strategies gives good reduction of anterior column, at the same time offers possibility to restore the posterior column from the anterior aspect using anterior to posterior column screws, obviating the need for a separate posterior approach.