Clinical and radiological outcomes of acetabulum fracture treated by modified stoppa approach

Purpose: The aim of the present study was to evaluate the results of the patients who were admitted to our clinic due to acetabulum fracture and treated by the Modified Stoppa approach. Material and method: Forty eight patients who were followed at least for 6 months were enrolled into the study. The fractures were confirmed by direct X-ray and 3 dimensional computed tomography and classified according to Judet-Letournel classification. Postoperative reduction quality and radiological evaluations during followup were performed according to Matta'a reduction quality and Matta's Radiological Scoring system. Clinical outcomes were evaluated by Modified Merle D'Aubigne Evaluation scale. Findings: Age average of the patients enrolled into the study was 40.75 (15-80). Mean follow-up period for the patients was .72 ± 5.95 (6-26) months. Etiology of the trauma that caused acetabulum fracture included falling from high for 20 patients (41.7%), extravehicular traffic accident for 17 patients (35.4%), in-vehicle traffic accident for 10 patients (20.8%), bomb explosion (firearm injury) for 1 patient (2.1%). Skeletal traction is performed to the patients until required preparations for the surgery. The average period for skeletal traction performed on the patients after the surgery was 5,02 days (0-24). In the present study, 2 patients had total sciatic symptoms and 2 patients had peroneal symptoms preoperatively. One patient developed iatrogenic peroneal nerve injury postoperatively. Peroneal symptoms completely recovered in 1 patient during postoperative follow-up. One patient had injury on external iliac vein during the surgical procedure and vascular repair was performed by a cardiovascular surgeon within same session. Urinary bladder rupture was observed in 2 patients during the surgery and repair was performed by urologist. Clinical failure was detected in 2 patients. One patient developed implant failure during postoperative follow-up; such patient was operated again and fixation was tried; however, due to osteoporotic nature of the bone, implant was removed and conservative treatment was performed. Total hip arthroplasty was implemented to a patient who had osteolysis on the femur head and severe hip pain during follow-up. According to Matta's Reduction quality criteria, 29 (60.4%) patients had anatomic, 14 (29.1%) patients had moderate and 5 (10.4%) patients had worse reduction. Matta's Radiological Scoring System evaluation conducted on latest follow-up X-rays revealed that 22 (45.8%) patients had very well, 11 (22.9%) patients had well, 9 (18.8%) patients had moderate and 6 (12.5%) patients had worse follow-up X-rays. Clinical outcomes were perfect in 10 (20.8%) patients, well in 24 (50%) patients, moderate in 7 (14.5%9 patients and worse in 7 (14.5%) patients according to Modified Merle d'Aubigne and postel criteria. Conclusion: The present study indicates that there is a strong association between reduction quality of acetabulum fractures, anatomic reduction done by stable fixation under optimum conditions and clinical outcomes. (p=0.002). Key Words: Acetabulum, pelvis, Letournel-Judet, Stoppa