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Injury of the obturator nerve in the modified Stoppa approach for acetabular fractures - 18/08/17

Doi : 10.1016/j.otsr.2017.03.005 
J.W. Kim a, H.C. Shon b, J.H. Park c,
a Department of orthopaedic surgery, Haeundae Paik hospital, Inje university, college of medicine, 875, Haeun-daero, 48108 Haeundae-gu, Busan, Republic of Korea 
b Department of orthopedic surgery, Chungbuk national university hospital, Chungbuk national university, college of medicine, 52, Naesudong-ro, 28644 Heungdeok-gu, Cheong-Ju, Republic of Korea 
c Department of orthopedic surgery, Kangbuk Samsung hospital, Sungkyunkwan university, school of medicine, 29, Saemunan-ro, Gyonam-dong, 03181 Jongno-gu, Seoul, Republic of Korea 

Corresponding author.

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Abstract

Introduction

The modified Stoppa approach for acetabular fractures has become popular. However, the possibility of injury to the obturator nerve with this approach has not been sufficiently considered. We have experienced a case of nerve entrapment in severely displaced fractures. Therefore, we performed a retrospective study to: (1) evaluate the incidence of obturator nerve injury in the modified Stoppa approach for acetabular fractures; (2) analyze the relationship between the extent of displacement of the quadrilateral plate and injury to the obturator nerve.

Hypothesis

We hypothesized that obturator nerve injury would be related to a marked medial displacement of the quadrilateral plate.

Patients and methods

We conducted a retrospective cohort study of 22 patients with acetabular fractures that were surgically treated with the modified Stoppa approach. The medial displacement of the quadrilateral plate was measured on a three-dimensional reconstruction image with the inlet view. Postoperative electrodiagnostic tests were performed based on clinical suspicion of neurological injury. Nerve injuries were divided into initial trauma or postoperative complication, and recovery of nerve function was evaluated. We identified the incidence of obturator nerve injury and analyzed the relationship between obturator nerve injury and medial displacement of the quadrilateral plate.

Results

The incidence of obturator nerve injury was 2/22 (9.1%), and all injuries resulted from the initial trauma. The average displacement of the quadrilateral plate was 15.9±13.4mm. Patients were divided into two groups, using a displacement of 24mm as a cutoff point, identified using a receiver operating characteristic curve analysis. There were 16 patients in group 1 (<24mm) and 6 patients in group 2 (≥24mm). The incidence of obturator nerve injury from trauma was 0/16 (0%) in group 1 and 2/6 (33.3%) in group 2 (P=0.018).

Conclusions

No cases of postoperative obturator nerve injury were identified. Preoperative obturator nerve injury was more common in patients with a displacement of the quadrilateral plate24mm.

Level of evidence

IV, retrospective study.

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Keywords : Acetabulum, Acetabular fracture, Approach, Obturator nerve, Complications


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Vol 103 - N° 5

P. 639-644 - septembre 2017 Retour au numéro
Article précédent Article précédent
  • Does semi-automatic bone-fragment segmentation improve the reproducibility of the Letournel acetabular fracture classification?
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