The Stoppa approach for acetabular fracture
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. Khoury · Y. Weill · R. Mosheiff Department of Kerem, Hadassah-Hebrew University Medical Center, Jerusalem
J. Kühn, Heidelberg
The Stoppa approach for acetabular fracture
Since the early work of Letournel, surgical treatment of acetabular fractures has be come the gold standard for unstable and displaced fracture patterns [12, 16, 17, 18, 19]. Surgical decision making entails frac ture classification and the surgical ap proach. The choice of surgical approach is based on the fracture pattern, direction of displacement, skin condition at the sur gical incision site, and duration from time of injury [18, 22]. Rigid internal fixation is obtained using various combinations of plates and screws after careful preopera tive planning. Fracture patterns involving medial dis placement, particularly of the quadrilate ral plate of the acetabulum, are technically challenging, due to the fracture’s location in the true pelvis, the limited bone stock, and the fracture’s proximity to the articu lar surface of the hip joint [7, 18, 20, 24]. Various approaches are well described in the literature and include the Ko cher–Langenbeck, iliofemoral, ilioingui nal, combined anterior and posterior ap proaches, extended iliofemoral, transtro chanteric, and triradiate approaches [2, 6, 9, 13, 14, 15, 16, 23, 25, 30, 31]. These ap proaches are usually classified as one of: limited or extensile, based on the degree of exposure accomplished; or anterior or posterior/intrapelvic or extrapelvic, based on the particular region of the acetabu lum exposed. The use of an intrapelvic ap proach assures adequate exposure of the pelvic ring, thereby facilitating reduction of the anterior wall and column fractures, anterior fractures associated with a post erior hemitransverse component, as well as both-column fractures. In addition, for certain fracture patterns, an intrapelvic approach allows for utilization of plating
configurations that are not possible with an extrapelvic approach [3]. The ilioinguinal, first described by Le tournel in 1961, is the only intrapelvic ap proach of the above mentioned approach es [15]. The use of this approach exposes the anterior column and part of the wall, enabling a limited view of the quadrilater al plate. This approach is indicated in all anterior column and wall fractures, asso ciated anterior column and posterior he mi-transverse fractures, selected both-col umn fractures, transverse and T-fractures. It is also recommended for the restora tion of displaced superior rami fractures [16, 17]. Its main limitations include lack of direct visualization of the acetabular sur face and lack of control in extensively dis placed posterior column fractures. The ilioinguinal’s main complications are a high rate of postoperative infections and iatrogenic injury to the iliofemoral blood vessels and the femoral nerve [7, 11, 21, 22]. Along with the evolution of minimally invasive techniques aimed at minimizing surgical dissection, attempts have been made to treat acetabular fractures with an even l
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