Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures: a single-institution review of 48 cases

  • Lee, Hyeonjoon (Department of Orthopedic Surgery, Chosun University Hospital, Chosun University College of Medicine) ;
  • Jo, Suenghwan (Department of Orthopedic Surgery, Chosun University Hospital, Chosun University College of Medicine) ;
  • Lee, Gwangchul (Department of Orthopedic Surgery, Chosun University Hospital, Chosun University College of Medicine) ;
  • Cho, Yongjin (Department of Orthopedic Surgery, Chosun University Hospital, Chosun University College of Medicine)
  • Received : 2021.08.09
  • Accepted : 2021.11.01
  • Published : 2022.03.30
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Abstract

Purpose: The current study aimed to report the perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures. Methods: We analyzed 48 consecutive operations in 45 patients who were treated with internal fixation using the modified Stoppa approach between March 2016 and July 2018. This included three revision operations. The mean age of the patients was 54.5 years, and the patients included 35 male patients and 10 female patients. All fractures occurred as a consequence of high-energy trauma and 70.3% had associated injuries at the time of the fracture. The mean Injury Severity Score was 9.03±5.60. The perioperative complications found during and immediately after surgery were recorded and were classified into three categories: vascular injuries, nerve injuries, and other complications. Results: Overall, 14 perioperative complications (29.2%) in 14 cases were identified. The most common complications were nerve injuries, which occurred in seven cases, all involving the obturator nerve. Uncontrollable vascular injuries occurred in six cases, which required additional incisions and support of vascular surgeons or postoperative interventions. Additionally, one case of peritoneal tearing occurred, which required help from an abdominal surgeon. Conclusions: While the modified Stoppa approach seems to be a viable method to treat pelvic fractures, significant perioperative complications may occur, suggesting that surgeons should pay careful attention to minimize the damage to other structures and that appropriate support from other surgical departments is paramount.

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References

  1. Borg T, Berg P, Larsson S. Quality of life after operative fixation of displaced acetabular fractures. J Orthop Trauma 2012;26:445-50. https://doi.org/10.1097/BOT.0b013e31824c07cb
  2. Kim HY, Yang DS, Park CK, Choy WS. Modified Stoppa approach for surgical treatment of acetabular fracture. Clin Orthop Surg 2015;7:29-38. https://doi.org/10.4055/cios.2015.7.1.29
  3. Hirvensalo E, Lindahl J, Bostman O. A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res 1993;(297):28-32.
  4. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Relat Res 1994;(305):112-23.
  5. Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabu- lum. A meta-analysis. J Bone Joint Surg Br 2005;87:2-9.
  6. Jakob M, Droeser R, Zobrist R, Messmer P, Regazzoni P. A less invasive anterior intrapelvic approach for the treatment of acetabular fractures and pelvic ring injuries. J Trauma 2006;60:1364-70. https://doi.org/10.1097/01.ta.0000208139.97474.f7
  7. Archdeacon MT, Kazemi N, Guy P, Sagi HC. The modified Stoppa approach for acetabular fracture. J Am Acad Orthop Surg 2011;19:170-5. https://doi.org/10.5435/00124635-201103000-00006
  8. Soni A, Gupta R, Sen R. Modified Stoppa approach for ace- tabulum fracture: a review. Rev Bras Ortop (Sao Paulo) 2019; 54:109-17. https://doi.org/10.1016/j.rboe.2017.09.006
  9. Khoury A, Weill Y, Mosheiff R. The Stoppa approach for ac- etabular fracture. Oper Orthop Traumatol 2012;24:439-48. https://doi.org/10.1007/s00064-011-0093-z
  10. Sanna B, Henry BM, Vikse J, et al. The prevalence and mor- phology of the corona mortis (Crown of death): a meta-anal- ysis with implications in abdominal wall and pelvic surgery. Injury 2018;49:302-8. https://doi.org/10.1016/j.injury.2017.12.007
  11. Laflamme GY, Hebert-Davies J, Rouleau D, Benoit B, Leduc S. Internal fixation of osteopenic acetabular fractures in- volving the quadrilateral plate. Injury 2011;42:1130-4. https://doi.org/10.1016/j.injury.2010.11.060
  12. Hammad AS, El-Khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches. Injury 2015;46:320-6. https://doi.org/10.1016/j.injury.2014.10.053
  13. Elmadag M, Guzel Y, Aksoy Y, Arazi M. Surgical treatment of displaced acetabular fractures using a modified Stoppa approach. Orthopedics 2016;39:e340-5.
  14. Isaacson MJ, Taylor BC, French BG, Poka A. Treatment of acetabulum fractures through the modified Stoppa ap- proach: strategies and outcomes. Clin Orthop Relat Res 2014; 472:3345-52. https://doi.org/10.1007/s11999-014-3460-x
  15. Kim JW, Shon HC, Park JH. Injury of the obturator nerve in the modified Stoppa approach for acetabular fractures. Or- thop Traumatol Surg Res 2017;103:639-44. https://doi.org/10.1016/j.otsr.2017.03.005
  16. Kacra BK, Arazi M, Cicekcibasi AE, Buyukmumcu M, Demirci S. Modified medial Stoppa approach for acetabular fractures: an anatomic study. J Trauma 2011;71:1340-4.
  17. Locher S, Burmeister H, Bohlen T, et al. Obturator nerve block: a technique based on anatomical findings and MRI analysis. Pain Med 2008;9:1012-15. https://doi.org/10.1111/j.1526-4637.2007.00364.x
  18. Meena S, Sharma PK, Mittal S, Sharma J, Chowdhury B. Modified Stoppa approach versus ilioinguinal approach for anterior acetabular fractures: a systematic review and meta-analysis. Bull Emerg Trauma 2017;5:6-12.