Pdf modified stoppa approach versus ilioinguinal approach for. Therefore, minimally invasive surgery is more appropriate. Fracture acetabulum is a challenging, difficult to treat orthopedic injury due to its location and associated concomitant injuries. The purpose of this study is to evaluate the clinical results of modified stoppa approach in acetabular fractures. The modified stoppa approach for reduction of fracture acetabulum improves access to quadrilateral surface and posterior column and is considered to be advantageous in many facets of the surgery. Rationales for the bernese approaches in acetabular surgery. Complications are represented by thrombosis after iliac vessels stretching and bladder. Nov 14, 2019 group a contained 36 26 males and 10 females patients with a mean age of 43. This video describes a step by step approach to perform the reduction and fixation of acetabular fractures from the front. In comparison with the modified stoppa approach, the pararectus approach provided a 10% increase in exposure and a twofold increase in screw lengths of the most posterior screw and the posterior column screw 8.
The purpose of this study is to assess the advantages of modified ilioinguinal approach in combined surgical exposures for displaced acetabular fractures involving two columns management. It can be concluded that the modified stoppa approach could be used as an alternative to the classic ilioinguinal approach. Midterm results of displaced acetabulum fractures surgically treated using anterior intrapelvic approach modified stoppa omur caglar 1, sayg. Though many authors combine modified stoppa approach with other approaches, certain modifications of the approach have also been described. Safety of modified stoppa approach for ganz periacetabular. Pdf modified stoppa approach in acetabular fractures. Modified ilioinguinal approach in combined surgical. Minimally invasive treatment of bothcolumn acetabular. Modified stoppa approach for acetabular fractures with. As a service to our customers we are providing this early version of the manuscript. Ota video library modified stoppa approach for fractures. The extrapelvic ilioinguinal il has been the workhorse for the anterior approach and remains the gold standard.
This is a pdf file of an unedited manuscript that has been accepted for publication. A randomized controlled clinical study was conducted to provide an. The choice of approach depends on the type of fracture, displacement and the surgeons preference 5. Thus, anterior component separation was developed to allow further myofascial advancement. C sagittal reconstruction ct showing 2 pieces of impacted fragment. Atlas of advanced operative surgery 1st edition pdf. The posterior column of the acetabulum was addressed via a kocher langenbeck approach and the anterior column was addressed with a pfannenstiel incision and a modifiedstoppa approach. Frequently a combination of the modified stoppa approach and the first window of the ilioinguinal approach has been carried out in the range 6093 % to gain access to the iliac wing 40, 41. To quantify the reduction of acetabular fractures with displacement of the anterior and posterior column by using only a single anterior approach that combines the modified stoppa approach with the lateral window of the classic ilioinguinal approach. Treatment results for acetabulum fractures using the modified. Since its introduction by hirvensalo and cole, the anterior intrapelvic approach aipa has been adopted by some surgeons, whilst others remain devoted to the iia.
Methodsthe ganz pao was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified stoppa approach through the pfannenstiel incision. 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. Then, the pelvic ring was exposed subperiosteally from the pubic symphysis to the anterior aspect of. Clinicoradiological outcomes of using modified stoppa. Posterior component separationtransversus abdominis release.
A modified stoppa technique approach for treatment of pediatric acetabular fractures modified stoppa as an alternative surgical approach for fixation of anterior fracture acetabulum. Compared to the modified stoppa approach, the suprailioinguinal approach provides a closer visualization to the. 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. The stoppa procedure in inguinal hernia repair rev. Jd cole and br bolhofner, acetabular fracture fixation via a modified stoppa limited intrapelvic approach. The stoppa procedure is a tensionfree type of hernia repair. Re stoppa, the treatment of complicated groin and incisional hernias, world j. Suprailioinguinal versus modified stoppa approach in the treatment. This approach was combined with a lateral approach on the iliac crest for fractures of the iliac wing. A consecutive cohort of 17 patients with displaced acetabular fractures treated operatively with use of only an anterior approach that combined the modified stoppa approach with the lateral window of the ilioinguinal approach.
In 1994, cole and bolhofner began to use it successfully as minimally invasive acetabulum surgery in adult patients. Functional outcome of acetabular fracture fixation by modified. Quantification of radiographic reduction and analysis of. In 2 cases one with the anterior column and posterior hemitransverse fracture and the other with bothcolumn fracture, a lateral window was made over the iliac crest simultaneously.
And as such, we considered this technique as a viable alternative for the ilioinguinal approach when exposure of the anterior acetabulum is needed. Internal fixation of unstable pelvic ring injuries via the modified stoppa approach 31 connecting vessel between the obturator and femoral artery, was identified and ligated. It is not uncommon for wines to age in barrel for years before bottling and then many more in bottle before release. Sep 28, 2018 in comparison with the modified stoppa approach, the pararectus approach provided a 10% increase in exposure and a twofold increase in screw lengths of the most posterior screw and the posterior column screw 8. May 17, 20 it is important to note that the newly modified stoppa approach combined with the lateral approach on the iliac crest could achieve the same visualization as the ilioinguinal approach fig. Traumatic testicular dislocation associated with lateral. Then, the pelvic ring was exposed subperiosteally from the pubic symphysis to the anterior aspect of the sacroiliac joint. While the fresher trebbiolo is sold the summer after its harvest, there are. In the the 1920s, he had to replant because of phylloxera, so the oldest vineyards we have are from this.
The rate of complications in this study associated with the newly modified stoppa approach is comparable to that reported for the aip modified rivesstoppa and ilioinguinal approaches. 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. Suprailioinguinal versus modified stoppa approach in the. A consecutive cohort of 60 patients from september 2014 to october 2017 with displaced acetabular fractures involving the quadrilateral plate were treated. Iia is routinely used in the republic of macedonia. The modified stoppa approach is considered an alternate to anterior approach, which provides. Treatment results for acetabulum fractures using the. This operation may be performed to correct hernias of the abdomen, groin, diaphragm, brain, or at the site of a previous operation. Fixation of pelvicacetabular fractures using a midlinemodified. Advance your surgical expertise with atlas of advanced operative surgery. The rivesstoppa technique for ventral hernia repair is commonly utilized due to wellproven outcomes with low overall morbidity. Like all surgical approaches, the modified stoppa is a. Apr 17, 2020 fracture acetabulum is a challenging, difficult to treat orthopedic injury due to its location and associated concomitant injuries. Modified stoppa approach for fractures of the acetabulum.
Acetabulum fractures archives trauma international. Modified stoppa approach for surgical treatment of acetabular. Ota video library modified stoppa approach for fractures of. A combination of the modified stoppa approach and the. The modified stoppa approach is an intrapelvic approach initially used for inguinal hernia surgery by rives et al. Abstractobjectivethe aim of this cadaveric study was to investigate the efficacy of the modified stoppa approach in ganz periacetabular osteotomy pao. Modified stoppa approach for operative treatment of. Apr 30, 2009 modified stoppa intrapelvic approach offers many advantages in the treatment of complex pelvic fractures. Article information, pdf download for fixation of pelvicacetabular. On hospital day three, the patient went to the operating room for an open reduction and internal fixation of the left acetabular fracture. This modified stoppa approach affords excellent visualization of the pelvic ring, facilitating the development and utilization of. Sep 14, 2012 the stoppa approach for acetabular fracture the stoppa approach for acetabular fracture khoury, a weill, y mosheiff, r. Modified stoppa approach was introduced as an alternative to ilioinguinal approach for.
They were followed up for at least 1 year postoperatively for radiographic and clinical assessments, which included the modified merle daubigne score, harris hip score, and pain visual analogue scale. However, the focus of interest, the acetabulum, lies between the first window and the modified stoppa approach. If the modified stoppa approach alone was insufficient for reduction or internal fixation, a lateral window was made along the iliac crest to fix the high anterior column fracture exiting the iliac crest or to fix the posterior column with a lag screw. It is performed by wrapping the lower part of the parietal peritoneum with prosthetic mesh and placing it at a preperitoneal level over fruchauds myopectineal orifice. Modified stoppa approach is effective for fixing acetabular. The aim of this study was to compare the clinical outcomes in patients with unstable anterior pelvic ring fractures after treatment with anterior subcutaneous internal fixator infix or plate. A modified stoppa technique approach for treatment of. Click for larger image download as powerpoint slide. The modified stoppa approach can be performed in isolation without the need for the lateral window when the iliac wing is not fractured. Modified stoppa as an alternative surgical approach for.
The major difference between the il and the stoppa approaches is that stoppa allows for the avoidance of the middle window of the il approach. He was the first to give value to this land by planting vineyards. Ota video library modified stoppa approach for fractures of the acetabulum cyril mauffrey, md on vimeo. A combination of the modified stoppa approach and the iliac. A total of 17 polytrauma patients with pelvic andor acetabular fractures were consecutively treated using the modified stoppa approach. Only the modified stoppa approach was used in hips, while the kocherlangenbeck approach was additionally used in 9 hips table 3. As dissection was carried down to the level of the rectus fascia. Introduction acetabular fractures are complex intraarticular fractures.
The stoppa approach for acetabular fracture the stoppa approach for acetabular fracture khoury, a weill, y mosheiff, r. Hernia repair refers to a surgical operation for the correction of a herniaa bulging of internal organs or tissues through the wall that contains it. D immediate postoperative pelvis anteroposterior image, showing a good reduction through the modified stoppa approach. Anterior subcutaneous internal fixator infix versus. The ilioinguinal approach versus the anterior intrapelvic. Acetabular fracture fixation via a modified stoppa limited i. A new approach to the internal fixation of unstable pelvic fractures. Modified stoppa approach for surgical treatment of acetabular fracture. The ilioinguinal approach iia to the acetabulum has been used as a golden standard for fifty years to treat anterior acetabular fractures. 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.
Metaanalysis of modified stoppa approach and ilioinguinal a. The midline approach for hernia treatment with a complicated incision was first described by stoppa in 1989. The second objective was to evaluate the interobserver variability of our technique for radiographic evaluation of the reduction. The stoppa approach for acetabular fracture, operative. Anterior subcutaneous internal fixator infix versus plate. Fixation of pelvicacetabular fractures using a midline. A modified stoppa approach in combination with an iliac fossa approach was used. In all of the cases, the anterior column was stabilized with reconstruction. In the case presented herein, a modified stoppa technique approach with anterior column fracture fixation was used.
Surgical approach to acetabulum may be anterior ilioinguinal, iliofemoral, stoppa approach 1,2, posterior kocherlangenbeck approach and variants 3 or combined simultaneous or different sittings 4. Apr 10, 2017 surgical approach to acetabulum may be anterior ilioinguinal, iliofemoral, stoppa approach 1,2, posterior kocherlangenbeck approach and variants 3 or combined simultaneous or different sittings 4. Illustrated images on the range of surgical exposure, according to the type of anterior pelvic approach. We herein present a case of an acetabulum anterior column posterior hemitransverse fracture following a traffic accident, which was treated surgically using a modified stoppa technique approach. The intrapelvic approach, also called the modified stoppa approach46, was introduced as a less invasive alternative to the extrapelvic ilioinguinal approach, mostly combined with the first window of the ilioinguinal. Feb 10, 2015 the modified stoppa approach is an intrapelvic approach initially used for inguinal hernia surgery by rives et al. This new resource picks up where other surgical references leave off, providing highly visual, stepbystep guidance on more than 100 advanced and complex procedures in both general and subspecialty areas. 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. Materials and methods twelve patients who underwent surgery using the modified stoppa approach for acetabular fractures were enrolled. Newly modified stoppa approach for acetabular fractures. Clinical results of acetabular fracture management with the. Description of operative technique and preliminary treatment results, clin. However, this approach is limited by the amount of myofascial advancement and sublay space available for a wide mesh overlap. E, f postoperative ct images, showing wellreduced dome impaction and congruent joint.
Hence, the modified stoppa approach msa can be adopted by a. Reduction technique of dome impaction using the modified. Abstract the ilioinguinal approach iia to the acetabulum has been used as a. The available data suggest that modified stoppa approach is useful in anterior acetabulum. In all of the cases, the anterior column was stabilized with reconstruction plates for the iliac wing and along the iliopectineal line to the pubis.