Novel Utilization of Anterior Intrapelvic (Stoppa) Approach for Periacetabular Ganz Osteotomy

Introduction: Periacetabular osteotomy (PAO) is an established treatment for symptomatic acetabular dysplasia in skeletally mature individuals without arthritis. Pelvic nonunion and associated stress fractures are under-reported. Nonunited stress fractures can cause continued buttock pain and pelvic instability. The aim of this study is to report on our experience managing patients with ongoing pain following nonunion of PAO. Patients and methods: 8 patients presented to a tertiary referral pelvic service with symptomatic PAO nonunion between 2015-2018. All patients underwent open reduction internal fixation of the superior pubic ramus nonunion, with ipsilateral iliac autograft, at an average of 48.1 (15–82) months following initial osteotomy. Demographic and perioperative data were recorded. Follow-up was on average to 9.9 months, once union was confirmed radiographically. Results: All patients were female and average age was 31.8 (18–41) years. In 7/8 (87.5%) patients a modified Stoppa approach was successfully utilised. 1 patient required an ilioinguinal approach due to the amount of rotational correction. All patients went on to union at the superior pubic ramus and reported improvement in mechanical symptoms. 5/8 (62.5%) patients were noted to develop union of the posterior column or inferior pubic ramus stress fracture indirectly. 2/8 (25%) patients developed progression of intra-articular pain, despite restoration of pelvic stability. 1 patient required intraoperative transfusion due to femoral vein injury. There were no other complications seen in this series. Conclusions: To our knowledge, this is the largest case series of surgically managed PAO nonunion. Pelvic instability resulting from nonunion and stress fracture can be satisfactorily addressed by mobilising, grafting and plating the nonunion at the superior pubic ramus. The modified Stoppa approach is suitable in most cases, allowing excellent exposure whilst minimising the insult to soft tissues. The altered anatomy of the pelvis following PAO should be anticipated to reduce the risk to nearby neurovascular structures.

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Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2020.10.007 ◽

2020 ◽

Vol 11 (6) ◽

pp. 1121-1127

Author(s):

Tushar Nayak ◽

Samarth Mittal ◽

Vivek Trikha ◽

Kamran Farooque ◽

Shivanand Gamanagatti ◽

...

Keyword(s):

Surgical Treatment ◽

Acetabular Fractures ◽

Short Term ◽

Stoppa Approach

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Internal Fracture Fixation Using the Stoppa Approach in Pelvic Ring and Acetabular Fractures: Technical Aspects and Operative Results

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000219693.95873.24 ◽

2006 ◽

Vol 61 (3) ◽

pp. 662-667 ◽

Cited By ~ 59

Author(s):

Kees-Jan Ponsen ◽

Pieter Joosse ◽

Arvid Schigt ◽

Carel J. Goslings ◽

Jan S. K. Luitse

Keyword(s):

Fracture Fixation ◽

Pelvic Ring ◽

Acetabular Fractures ◽

Technical Aspects ◽

Operative Results ◽

Internal Fracture Fixation ◽

Stoppa Approach ◽

Internal Fracture

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Fixation of Pelvic-Acetabular Fractures Using a Midline-Modified Stoppa Approach: Clinical and Operative Outcomes

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.01.001 ◽

2018 ◽

Vol 24 (1) ◽

pp. 18-24

Author(s):

Kenneth Kin-yan Chan ◽

King-him Chui ◽

Ka-chun Ip ◽

Kin-bong Lee ◽

Wilson Li

Keyword(s):

Complication Rate ◽

Injury Severity ◽

Pelvic Ring ◽

Functional Results ◽

Bimodal Distribution ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Pelvic Ring Fractures ◽

Stoppa Approach ◽

Polytrauma Patients

Background/Purpose This served as the first report from our locality to evaluate the modified Stoppa approach, via a low-midline wound, for treating pelvic–acetabular fractures. Methods A total of 17 polytrauma patients with pelvic and/or acetabular fractures were consecutively treated using the modified Stoppa approach. They were followed up for at least 1 year postoperatively for radiographic and clinical assessments, which included the Modified Merle d'Aubigne Score, Harris Hip Score, and pain visual analogue scale. Results Among the 17 patients, 11 had pelvic ring fractures, two had isolated acetabular fractures, and four had a combination of both. Excellent and anatomical reduction was achieved in 73.3% of pelvic fractures and 71.4% of acetabular fractures. Functional outcomes simulated a bimodal distribution. Age of patient and Injury Severity Score were significant predictors for functional results, whereas fracture characteristics and quality of reduction were not correlated with clinical outcomes in this series. We experienced a low complication rate. Conclusion Excellent exposure for fracture reduction and fixation with low complication rate was achieved with the modified Stoppa approach. We were encouraged by the results of this preliminary series for treating pelvic–acetabular fractures in polytrauma patients.

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