Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results.

Between March 1991 and December 1992 the authors surgically treated 55 acetabular fractures using a modified Stoppa anterior intrapelvic extensile approach. Indications for utilization of this approach included displaced anterior column or wall fractures, transverse fractures, T shaped fractures, both column fractures and anterior column or wall fractures associated with a posterior hemitransverse component. The approach involves a transverse skin incision 2 cm above the pubic symphysis followed by a midline split of the rectus abdominis. Access to the intrapelvic aspect of the pelvis and acetabulum is gained by retraction of the muscular, neurovascular and urological structures. This modified Stoppa approach affords excellent visualization of the pelvic ring, facilitating the development and utilization of improved reduction and plating options. Patients were followed for an average of 17.7 months. All fractures united 6-12 weeks postoperatively. Radiographic grades were excellent (64%), good (25%), fair (7%) and poor (4%). Fixation and subsequent reduction were lost in 1 patient. Two transient obturator nerve palsies were diagnosed. There was 1 infection and 1 inguinal hernia. Posttraumatic arthritic changes were noted in 6 patients within the first postoperative year. There was no significant heterotopic ossification, major vascular injury iatrogenic palsy or intraarticular hardware placement. Clinical results were excellent (47%), good (42%), fair (9%) and poor (2%). The modified Stoppa incision offers the experienced trauma surgeon a new approach for fixation of displaced acetabular fractures. The approach offers improved reduction and fixation possibilities and may decrease the rate of complications associated with extrapelvic or extensile approaches.