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Vertical Versus Pfannenstiel Incision-Modified Stoppa Approach in the Treatment of Acetabular Fractures

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Date
2024-03-01
Authors
Kara D.
ELMADAĞ N. M.
Ali J.
Misir A.
Cetin H.
DEMİRKIRAN C. B.
Mraja H.
Pulatkan A.
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Abstract
OBJECTIVES:The aims of this study were to compare the patient and fracture characteristics, radiological, functional, and quality of life outcomes; the need for a lateral window approach and requirement of total hip arthroplasty; and complications in patients with simple and complex acetabular fractures who underwent a modified Stoppa approach through vertical and Pfannenstiel incisions.METHODS:Design:This was a retrospective comparison study.Setting:Level 1 trauma center.Patient Selection Criteria:Patients with acetabular fractures (A-O-/-O-T-A type 62A-B-C) treated with vertical (group V) or Pfannenstiel (group P) incision-modified Stoppa approach between 2010 and 2020 were included.Outcome Measures and Comparisons:Patient characteristics, radiological evaluations (reduction quality and posttraumatic osteoarthritis), patient functional outcomes [12-item Short-Form Survey (SF-12) physical component score, SF-12 mental component score, Harris Hip Score, and Merle d\"Aubigné-Postel], approach modifications and stratification by fracture type and complications were compared between those treated with vertical or Pfannenstiel incisions.RESULTS:One hundred four patients (mean age of 38.5 ± 14.3 years) were included. There was no significant difference between the Pfannenstiel or vertical groups regarding patient and fracture characteristics (P = 0.137), postoperative reduction quality (P = 0.130), or the mean functional and quality of life outcome scores at the last follow-up (P = 0.483 for the Harris Hip Score, P = 0.717 for the Merle d\"Aubigné-Postel score, P = 0.682 for the SF-12 physical component score, and P = 0.781 for the SF-12 mental component score). In group P, significantly more patients needed additional lateral incisions (40.8% vs. 10.9%; P 0.001) and total hip replacement procedures (12.2% vs. 1.8%; P = 0.049). The total, early, and late complication rates were significantly higher in group P (P 0.001, P = 0.034, and P = 0.049, respectively).CONCLUSIONS:Pfannenstiel incision was associated with higher complication rates than vertical incision in acetabular fractures treated through a modified Stoppa approach. Fracture complexity is associated with the need for a lateral window approach and total hip arthroplasty, as well as a worse functional and radiological outcome regardless of incision type. However, it was not associated with the development of intraoperative or postoperative complications.LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Tıp, Cerrahi Tıp Bilimleri, Ortopedi ve Travmatoloji, Sağlık Bilimleri, Medicine, Surgery Medicine Sciences, Orthopedics and Traumatology, Health Sciences, Klinik Tıp (MED), Klinik Tıp, CERRAHİ, ORTOPEDİ, Clinical Medicine (MED), CLINICAL MEDICINE, SURGERY, ORTHOPEDICS, Cerrahi, Ortopedi ve Spor Hekimliği, Surgery, Orthopedics and Sports Medicine, acetabular fracture, complex, complications, modified Stoppa, outcome, Pfannenstiel, vertical
Citation
Kara D., ELMADAĞ N. M., Ali J., Misir A., Cetin H., DEMİRKIRAN C. B., Mraja H., Pulatkan A., "Vertical Versus Pfannenstiel Incision-Modified Stoppa Approach in the Treatment of Acetabular Fractures", Journal of Orthopaedic Trauma, cilt.38, sa.3, ss.134-142, 2024
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