W Lehmann1, F Fensky1, M Hoffmann1, J M Rueger1. 1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf.
Abstract
OBJECTIVE: The Stoppa approach in its modified form is an intrapelvine approach for the treatment of acetabular fractures. It is an alternative to the ilioinguinal approach. Goals are the gentle soft-tissue preparation, anatomic reduction and stable internal fixation. Here, the approach is described in detail together with possible expansion possibilities. INDICATIONS: The Stoppa approach in particular is used for the treatment of fractures of the anterior column with participation of the quadrilateral surface, transverse fractures, T-type fractures, but also 2-column fractures when the main pathology is located in anterior portions of the acetabulum. METHOD: This intrapelvic approach allows a direct view of the quadrilateral surface and the direct reduction of these fragments. In contrast to the ilioinguinal access the Stoppa approach dispenses with the preparation of the 2nd window with exposure of the vessels. The preparation is carried out via a Pfannenstiel access following transection of the median line alba. The further dissection is performed along the anterior pubic ramus, on the pelvic rim, towards the ipsilateral sacroiliac joint. CONCLUSION: The modified Stoppa approach is a soft-tissue-friendly approach for the treatment of acetabular fractures. With its options for expansion, possibility for osteotomy of the anterior superior iliac spine and the use of the first ilioinguinal window, almost all types of fractures of the acetabulum whose primary pathology is on the anterior side can be treated. Georg Thieme Verlag KG Stuttgart · New York.
OBJECTIVE: The Stoppa approach in its modified form is an intrapelvine approach for the treatment of acetabular fractures. It is an alternative to the ilioinguinal approach. Goals are the gentle soft-tissue preparation, anatomic reduction and stable internal fixation. Here, the approach is described in detail together with possible expansion possibilities. INDICATIONS: The Stoppa approach in particular is used for the treatment of fractures of the anterior column with participation of the quadrilateral surface, transverse fractures, T-type fractures, but also 2-column fractures when the main pathology is located in anterior portions of the acetabulum. METHOD: This intrapelvic approach allows a direct view of the quadrilateral surface and the direct reduction of these fragments. In contrast to the ilioinguinal access the Stoppa approach dispenses with the preparation of the 2nd window with exposure of the vessels. The preparation is carried out via a Pfannenstiel access following transection of the median line alba. The further dissection is performed along the anterior pubic ramus, on the pelvic rim, towards the ipsilateral sacroiliac joint. CONCLUSION: The modified Stoppa approach is a soft-tissue-friendly approach for the treatment of acetabular fractures. With its options for expansion, possibility for osteotomy of the anterior superior iliac spine and the use of the first ilioinguinal window, almost all types of fractures of the acetabulum whose primary pathology is on the anterior side can be treated. Georg Thieme Verlag KG Stuttgart · New York.