Surgical Treatment of Displaced Acetabular Fractures Using a Modified Stoppa Approach

Abstract

A retrospective evaluation was performed of 36 patients (25 males and 11 females; average age, 44 years) with displaced acetabular fractures who were treated with a modified Stoppa approach. Fractures included 18 anterior columns, 2 both columns, 8 anterior columns with posterior hemitransverse, 6 transverse, and 2 T-type, according to the Judet and Letournel classification. Range of motion, Harris Hip Scores, and Merle d-Aubigne scores were evaluated. Pre- and postoperative measurements taken included displacements and gaps on axial, coronal, and sagittal computed tomography (CT) images and postreduction quality assessed radiologically. Mean follow-up was 14.7 months. Mean perioperative bleeding was 970 cc (range, 800-1250 cc). Mean Harris Hip Score was 77.9, mean Merle d-Aubigne score was 16.4, mean flexion was 105.2 degrees, and mean extension was 16.9 degrees. Anatomical reduction of the acetabular fracture was achieved in 29 (80.5%) patients; it was satisfactory in 5 (13.8%) and poor in 2 (5%). Mean preoperative displacements on axial, coronal, and sagittal sections were 4.1, 3.6, and 3.1 mm, respectively, and mean postoperative displacements were 0.2, 0.3, and 0.2 mm, respectively. Mean preoperative gap distance was 14.5 mm, and mean postoperative gap distance was 1.1 mm. Postoperative foot drop was observed in 2 patients, obturator nerve damage in 1, partial iliac vein damage in 1, and avascular necrosis of the femoral head in 1. Despite a steep learning curve, the modified Stoppa approach is a good alternative to the ilioinguinal approach. It can be used to treat many complex acetabular fractures.