[Surgical treatment of pelvic ring and acetabular fractures using the Stoppa approach].

PURPOSE OF THE STUDY: The Stoppa approach used in acetabular and pelvic ring fractures provides an excellent visualisation of the anterior column, quadrilateral plate and part of the posterior column for its exact reduction. Our first experience of this surgical approach and preliminary results are reported.

MATERIAL AND METHODS: Between April 2008 and September 2009, the Stoppa approach was used 15 times in 14 patients. This series includes 13 males and one female with an average age of 47.7 years. The mean follow-up was 6.8 months (range from 3 to 15) in 11 patients. In three patients, the post-operative period was too short for evaluation. The surgical procedure is described in detail and associated risks are rated. The Harris hip score was used for clinical evaluation. Radiographic results were assessed according to the criteria described by Matta and Pohlemann.

RESULTS: Ten patients suffered from an isolated acetabular fracture, two displayed an acetabular fracture combined with the pelvic ring injury. An isolated pelvic ring fracture was identified in one patient. One patient sustained an acetabular and pelvic ring fracture at one side associated with a simple pelvic ring injury contra-laterally. In five cases, surgery was carried out using three approaches; two approaches were used in another five patients. In remaining five cases, an isolated Stoppa approach was used. An exact anatomical or satisfactory reconstruction of the acetabulum was achieved in 10 patients; in three patients a poor result with 5-mm displacement was found. The pelvic ring fractures were anatomically reduced in two patients. The average Harris hip score in nine patients was 85 points (range from 70 to 95). No serious intra-operative vascular or nerve damage was detected, deep wound infection was revealed in one case.

DISCUSSION: The Stoppa approach makes the surgery of the anterior column and quadrilateral plate easier. It can be combined with other surgical techniques, usually with an approach using an "iliac window" over the iliac crest or with a Kocher-Langenbeck's approach. Indications for this type of surgery include acetabular fractures, combined acetabular and pelvic ring fractures and pelvic ring fractures without an injury to the acetabulum as well. Compared to the conventional ilioinguinal approach, the Stoppa approach is less extensive and does not endanger integrity of the lateral femoral cutaneous nerve. It facilitates the treatment of fractures in the posterior part of the quadrilateral plate because the visual control of reduction allows us to restore anatomical conditions. Some technical problems may occur if the screws inserted from the posterior approach into the fracture line of the inner acetabular surface, in order to stabilise the posterior column, interfere with an exact reduction. The use of a narrow plate for stabilisation of comminuted fractures of the quadrilateral plate may create problems as well.

CONCLUSIONS: The Stoppa approach changes the conditions for treatment of acetabular and pelvic ring fractures fundamentally. It affords an excellent visualisation of the anterior column and quadrilateral plate and allows for an exact reduction and stable fixation of their fractures. In combination with other approaches it permits anatomic reconstruction of the most serious fractures of the acetabulum and pelvic ring.