Outcomes of the Modified Stoppa Approach in Acetabular Fracture Management: Incidence of Nerve Injuries

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Orthopedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10.22038/abjs.2023.75631.3498

Abstract

Objectives: Displaced acetabular fractures are complex injuries that necessitate precise surgical 
intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa 
approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative 
technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk 
of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional 
outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures.
Methods: This retrospective study involved 86 patients with anterior column fractures, whose data were 
prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were 
pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or 
inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological 
assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip 
Score (HHS).
Results: Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in 
six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage 
was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms 
improved in all patients, except for the four patients with iatrogenic nerve damage.
Conclusion: Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less 
optimistic prognosis, potentially resulting in lasting neurological deficits.
 Level of evidence: III

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