The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: A case control study assessing blood loss complications and function outcomes - 24/08/14

Doi : 10.1016/j.otsr.2014.05.020

M. Elmadağ ^a, Y. Güzel ^b,^⁎ , M. Ali Acar ^c, G. Uzer ^a, M. Arazi ^d
^a Department of orthopaedics and traumatology, School of medicine, Bezmialem Vakıf university, Adnan Menderes Boulevard (Vatan street), 34093 Fatih, İstanbul, Turkey
^b Department of orthopaedics and traumatology, School of medicine, Campus of Cumhuriyet, Ordu university, 52200 Center/Ordu, Turkey
^c Department of orthopaedics and traumatology, Selçuklu school of medicine, Campus of Alaeddin Keykubat, Selçuk university, 42075 Selçuklu/Konya, Turkey
^d Department of orthopaedics and traumatology, Special Farabi Hospital, Veysel Karani Street, 42075 Selçuklu/Konya, Turkey

^⁎Corresponding author. Department of orthopaedics and traumatology, School of medicine, Campus of Cumhuriyet, Ordu university, 52200, Center/Ordu, Turkey. Tel.: +90 50 56 99 63 68.

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Abstract

Background

The modified Stoppa approach was introduced to manage fracture of the anterior column instead of the ilioinguinal approach to reduce morbidity. However there is no clinical evidence to confirm its efficiency. Therefore this study was designed to ascertain: (1) if the Stoppa approach versus ilioinguinal allows less blood loss, (2) if functional and radiological results are superior to that of the ilioinguinal approach, (3) if the rate of complication was different.

Hypothesis

The modified Stoppa approach allows less blood loss than the ilioinguinal in management of fractures of the anterior column of the acetabulum.

Patients and methods

Nineteen patients who were treated with the ilioinguinal approach (Group A) at a mean follow-up of 33 months and 17 patients who were treated with the modified Stoppa approach (Group B) at a mean follow-up of 28.9 months were retrospectively reviewed. Patients were called to the final follow-up examination, mean follow-up durations were set and the functional evaluation of patients was made with measurement of range of motion, Harris Hip Scores (HHS), and Merle D’Aubigné score.

Results

Average blood loss was determined at a mean 1170mL (range, 750–2150mL) in Group A and at a mean 1110mL (range, 450–2000mL) in Group B (P=0.168). The mean HHS (group A=89.4 [73–99] and group B=88.4 [75–97]) and Merle D’Aubigné scores (group A=16.8 [13–18] and group B=16.5 [13–18]) showed no significant difference between the groups (P=0.169). At the final follow-up, the mean hip flexion was found to be 106.83±12.47 and the hip extension was 10.33±6.12 in Group A, while these values were 103.71±14.32 and 10.69±8.17 in Group B (NS between groups regarding flexion [P=0.678] and extension [P=0.445]). The complication rate was 31% in Group A (6 patients) and 23% in Group B (4 patients) (P>0.05).

Discussion

Both surgical approaches give successful results in the treatment of acetabular fractures. Contrary to expectations, there was no difference in the amount of bleeding at the wound site from the Stoppa technique, even though it is minimally invasive, compared to the ilioinguinal approach.