Clin Orthop Surg.  2016 Sep;8(3):243-248. 10.4055/cios.2016.8.3.243.

Stoppa Approach for Anterior Plate Fixation in Unstable Pelvic Ring Injury

• Oh HK
• Choo SK
• Kim JJ
• Lee M

• KMID: 2374268
• DOI: http://doi.org/10.4055/cios.2016.8.3.243

Abstract

BACKGROUND
The Stoppa (intrapelvic) approach has been introduced for the treatment of pelvic-acetabular fractures; it allows easy exposure of the pelvic brim, where the bone quality is optimal for screw fixation. The purpose of our study was to investigate the surgical outcomes of unstable pelvic ring injuries treated using the Stoppa approach for stable anterior ring fixation.
METHODS
We analyzed 22 cases of unstable pelvic ring injury treated with plate fixation of the anterior ring with the Stoppa approach. We excluded cases of nondisplaced rami fracture, simple symphyseal diastasis, and parasymphyseal fractures, which can be easily treated with other techniques. The average age of the study patients was 41 years (range, 23 to 61 years). There were 10 males and 12 females. According to the Young and Burgess classification, there were 12 lateral compression, 4 anteroposterior compression, and 6 vertical shear fracture patterns. The fracture location on the anterior ring was near the iliopectineal eminence in all cases and exposure of the pelvic brim was required for plate fixation. All patients were placed in the supine position. For anterior plate fixation, all screws were applied to the anterior ramus distally and directed above the hip joint proximally. Radiologic outcomes were assessed by union time and quality of reduction by Matta method. The Merle d'Aubigne-Postel score was used to evaluate the functional results.
RESULTS
The average radiologic follow-up period was 16 months (range, 10 to 51 months). All fractures united at an average of 3.5 months (range, 3 to 5 months). According to the Matta method, the quality of reduction was classified as follows: 16 anatomical (73%) and 6 nearly anatomical (27%) reductions. There were no cases of screw or implant loosening before bone healing. The functional results were classified as 7 excellent (32%), 12 good (55%), and 3 fair (13%) by the Merle d'Aubigne-Postel score. There were no wound complications, neurovascular injuries, or other complications related to the surgical approach.
CONCLUSIONS
Stable anterior ring fixation placed via the Stoppa approach can result in excellent reduction and stable screw fixation with a low complication rate.

Keyword

Pelvis; Fracture fixation

MeSH Terms

Adult
Female
Fracture Fixation, Internal/adverse effects/*methods
Hip Fractures/*surgery
Humans
Male
Middle Aged
Pelvic Bones/injuries/*surgery
Pelvis/injuries/*surgery
Retrospective Studies
Young Adult

Figure

• 

  Fig. 1 A 36-year-old female sustained a hemodynamically unstable pelvic ring injury. (A) The plain X-ray shows an anteroposterior compression pelvic injury with transsacral fracture and symphyseal disruption. There was also bilateral superior pubic ramus fracture. (B) Temporary external fixation was performed as a damage control surgery. (C) Definite anterior plate fixation was carried out through a single midline vertical incision.

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  Fig. 2 The sequence of indirect reduction of a displaced anterior ring using a prebent plate is shown. (A) The prebent plate was applied on the disrupted anterior ring. (B) Displaced fracture was reduced to the plate by cortical screw insertion. (C) Acceptable reduction of the anterior ring could be obtained with the prebent plate.

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  Fig. 3 (A) Intraoperative photograph of a midline vertical incision. (B) There is no limit on the peripheral plate access or the trajectory of the peripheral plate screws.

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  Fig. 4 (A) Unstable pelvic ring injury in a 43-year-old female. (B) Stable anterior ring fixation combined with posterior fixation can increase the stability of the entire pelvis.

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