This study retrospectively analyzed 20 patients with a minimum 2year followup among the 22 patients with acetabular fractures who underwent operation via the modified stoppa approach. Indications and contraindications general agreement exists for the use of the modified stoppa approach for all fractures that can be managed. Left total hip arthroplasty through modified hardinge approach. The modified stoppa approach to the anterior pelvis was used in 22 cases instead of the ilioinguinal approach, which is the most widely used anterior approach. This approach also provides access as to the sciatic buttress, sciatic notch, and anterior sacroiliac joint. Acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons. This approach was described by cole and hirvensalo in the early 1990s. Stoppa approach to acetabulum posterior approach to the acetabulum kocherlangenbeck ilioinguinal approach to the acetabulum. This metaanalysis shows that the rates of achieving anatomical reduction by modified stoppa approach are higher than those achieved by the ilioinguinal approach. The purpose of this study is to provide an update on our experience with this approach for operative treatment of acetabular fractures and to assess. Ota video library modified stoppa approach for fractures. Figure 5 from the modified stoppa approach for acetabular. In the case presented herein, a modified stoppa technique approach with anterior column fracture fixation was used. Clinical image demonstrating two incision approach reference 1.
Incision length was 612 cm mean, 10 cm, operative duration was 50150 minutes mean, 85 minutes, and intraoperative blood loss. The modified medial stoppa approach is an alternative and new surgical approach to access to the internal pelvis and medial wall of the acetabulum. Suprailioinguinal versus modified stoppa approach in the. Modified stoppa approach for surgical treatment of acetabular. Use of the aip modified rivesstoppa approach for the treatment of acetabular fractures permits good to excellent reduction in the majority of cases while giving excellent visualization and access to the quadrilateral plate and posterior column. This approach was first described by hirvensalo et al in 1993. Internal fixation of unstable pelvic ring injuries via the modified stoppa approach 31. Randomized, controlled trial of the modified stoppa versus. The modified stoppa approach facilitates the management of fractures of the anterior column such as the socalled anterior column posterior hemitransverse, very low anterior column, and low anterior column fractures. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test.
The stoppa approach for acetabular fracture springerlink. The lateralrectus approach is a valuable alternative to the ilioinguinal and modified stoppa approach, being the treatment of acetabular. It was revised for pelvic and acetabular surgery by hirvensalo et al in 1993. Safety of modified stoppa approach for ganz periacetabular. The modified stoppa approach, which provided successful reduction of anterior column fractures and their components, including some complex acetabular fractures, is an alternative technique to the. Modified stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter.
The modified stoppa approach for acetabular fracture surgery has gained significant popularity and early results have been encouraging but clinical outcome at extensive followup is scarce. The modified stoppa approach is an intrapelvic approach initially used for inguinal hernia surgery by rives et al. In this retrospective study, we compared the suprailioinguinal approach and the modified stoppa approach for the treatment of acetabular fractures. An example of such is the modified stoppa approach. Internal fixation of unstable pelvic ring injuries via the. Learn about the acetabulum stoppa approach, an online 3dvideobased course, accredited by the royal college of surgeons of england. The modified stoppa approach for acetabular fracture. Alessandro aprato t type acetabular fracture treated through surgical hip dislocation. Pdf modified stoppa approach for surgical treatment of. Newly modified stoppa approach for acetabular fractures.
The modified stoppa approach in the treatment of a tshaped acetabular fracture surgical video technique march 01, 2017 contributors. It can be concluded that the modified stoppa approach could be used as an alternative to the classic ilioinguinal approach. It was later described as the anterior intrapelvic approach aip. Like all surgical approaches, the modified stoppa is a. Open reduction and internal fixation of acetabular. Hip direct lateral approach hardinge, transgluteal. Modified stoppa approach by cyril mauffrey youtube. The full text of this article is available in pdf format. Modified rivesstoppa repair for abdominal incisional hernias. Percutaneous screw fixation of acetabular fractures 17. As an alternative to the modified stoppa approach, the pararectus approach is used clinically for treatment of acetabular fractures involving the anterior column. Md jaaos journal of the american academy of orthopaedic surgeons.
We believe that the stoppa approach with an iliac window extension, previously described as a modified stoppa approach is adequate for the majority of acetabular fractures excluding those with. Internal fixation of acetabular fractures in an older population using. Right total hip arthroplasty through modified hardinge approach. The aim of this cadaveric study was to investigate the efficacy of the modified stoppa approach in ganz periacetabular osteotomy pao. The modified stoppa approach in the treatment of a t shaped acetabular fracture surgical video tech duration. It can be used to access the entire anterior column when supplemented with a lateral window, and allows excellent visualization of the quadrilateral surface. The objective of this study was to determine whether the modified stoppa approach or the ilioinguinal approach is better for the treatment of acetabular fractures by comparing the results of those 2 approaches. As an extension to the modified stoppa approach, the first window of the ilioinguinal approach.
Modified stoppa approach for fractures of the acetabulum 05. A randomized trial was undertaken of 60 consecutive patients with acetabular fractures treated with either the modified stoppa or the. Article pdf available in clinics in orthopedic surgery 71. Acetabular fracture fixation via a modified stoppa limited i. Modified stoppa approach versus ilioinguinal approach for. We believe that the stoppa approach with an iliac window extension, previously described as a modified stoppa approach is adequate for the majority of acetabular fractures excluding those with predominant posterior wall involvement. In 1994, cole and bolhofner began to use it successfully as minimally invasive acetabulum surgery in adult patients. Their conclusion suggested that this could be a potentially safer approach for dissection and access to acetabular fractures. A consecutive cohort of 60 patients from september 2014 to october 2017 with displaced acetabular fractures involving the quadrilateral plate were treated. Modified stoppa approach for surgical treatment of. There is little information about the clinical anatomic specifications of exposure in the literature.
To compare the efficacy of the operative techniques, complications, reduction quality and hip functional recovery by using the suprailioinguinal approach and the modified stoppa approach for the management of acetabular fractures. Modified stoppa approach for operative treatment of. This approach was combined with a lateral approach on the iliac crest for fractures of the iliac wing. Omar al bardan only the paranoid survive 8,068 views. In this paper we will present our experience in using the stoppa approach. The stoppa approach versus the ilioinguinal approach for anterior. Then, the pelvic ring was exposed subperiosteally from the pubic symphysis to the anterior aspect of the sacroiliac joint. Modified stoppa approach for fractures of the acetabulum cyril mauffrey, md. Modified stoppa approach for fractures of the acetabulum. The modified stoppa, or anterior intrapelvic, approach to the acetabulum provides straightforward anatomic exposure that can be used for direct access to the pelvic brim, posterior column of the acetabulum, and the quadrilateral surface. Hip direct lateral approach hardinge, transgluteal jason mckean travis snow john badylak 0 % topic. A modified stoppa technique approach for treatment of pediatric acetabular fractures mehmetelmadag 1 andmehmetaliacar 2 department of orthopedics and traumatology, medical faculty, bezmialem vakif university, fatih, istanbul, turkey department of orthopedics and traumatology, selcuklu medicine faculty, selcuk university, konya, turkey. The stoppa approach is used in the repair of inguinal hernias. Modified medial stoppa approach for acetabular fractures.
Ischial osteotomy through modified stoppa approach 5. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site. A similar approach modified stoppa was described in 1994 by cole et al. Of the 83 patients initially identified, 19 patients were excluded due to incomplete medical records. The modified stoppa approach in the treatment of a t. The pro system is designed to facilitate the anterior intrapelvic or modified stoppa approach, which is a less invasive alternative surgical approach to treating acetabular fractures. This video describes a step by step approach to perform the reduction and fixation of acetabular fractures from the front. Modified stoppa approach provides direct access to the pubic bones, the posterior surface of the ramus, the quadrilateral surface, the pubic eminence, and the infrapectineal surface. The ganz pao was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified stoppa approach through the pfannenstiel incision. The anterior intrapelvic modified rivesstoppa approach. Modified stoppa approach for surgical treatment of acetabular fracture. The modified stoppa ie, aip approach provides improved exposure of the quadrilateral surface and posterior column.
The intrapelvic modified stoppa approach is an important anterior exposure for acetabular trauma surgery. Stoppa approach to acetabulum approaches orthobullets. Hirvensalo et al and cole and bolhofner described a modified stoppa approach involving an anterior intrapelvic aip extraperitoneal approach through the rectus abdominis muscle for internal fixation of pelvic and acetabular fractures. Recent studies have reported relatively less blood loss and less operative time with stoppa approach 17.
The improved visualization provided by this approach facilitates fracture reduction and stabilization. This video described the surgical technique and our 11 steps to perform a modified stoppa approach. The newly modified stoppa approach was performed to fix the acetabular fractures with main anterior displacement and the anterior and lateral parts of the pelvis. This approach to the anterior intrapelvic region allows visualization of. Between january 2000 and august 2003, 83 patients in the practice of one surgeon at a large urban academic hospital the ohio state university medical center underwent a modified rivesstoppa incisional hernia repair. The modified stoppa approach for acetabular fracture archdeacon, michael t.
However, the efficacy of either approach over other is not well established. This modified stoppa approach affords excellent visualization of the pelvic ring, facilitating the development and utilization of. Surgical exposures and options for instrumentation in. It can be used to access anterior fractures of the pelvic ring as far laterally as the acetabulum. Surgical treatment of displaced acetabular fractures using. General agreement exists for the use of the modified stoppa approach for all fractures that can be managed with an ilioinguinal approach. In addition, comminution of the acetabular fracture was an important factor causing nonanatomic reduction and finally unsatisfactory clinical results. Pdf the stoppa approach for acetabular fracture researchgate. Case report a modified stoppa technique approach for. The modified stoppa approach can be performed in isolation without the need for the lateral window when the iliac wing is not fractured. The current study assessed the surgical exposure and the options for instrumentation using both of these approaches. Modified stoppa, ilioinguinal, acetabulum fractures. Additionally, with the aip approach, the socalled middle window of the ilioinguinal approach can frequently be avoided, resulting in minimal dissection of the inguinal canal, femoral nerve, and external iliac vessels. Modified stoppa intrapelvic approach offers many advantages in the treatment of complex pelvic fractures.
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