Fri., 10/17/08 Pelvis/Injury Prevention, Paper #31, 12:02 pm OTA-2008
The Modified Rives-Stoppa Approach for the Treatment of Acetabular Fractures
Alan Afsari, MD1 (n);
H. Claude Sagi, MD2 (a,b,c,e-Smith + Nephew; b-AO; b,e-Stryker; a,e-Synthes);
1Loma Linda University, Loma, California, USA
2Florida Orthopaedic Institute, Tampa, Florida, USA;
Purpose: Our objective is to report the technical aspects, radiographic results, and complications of the modified Rives-Stoppa approach as an alternative to the ilioinguinal approach for the treatment of acetabular fractures.
Methods: In this retrospective review of 630 acetabular fractures from February 2004 to February 2007, 49 acetabular fractures were reduced and stabilized using the modified Rives-Stoppa approach as an alternative to the ilioinguinal approach. The lateral window (along the crest) of the ilioinguinal approach was used in 34 of the patients without exposing or dissecting the inguinal ligament and canal. Charts and radiographs were reviewed for fracture pattern, time to surgery, operative time, blood loss, quality of reduction (Matta), and perioperative complications.
Results: There were 22 associated both-column, 12 anterior column, 7 anterior column posterior hemitransverse, and 8 transverse fractures. Average time to operation was 5 days. Average blood loss was 750 cm3, and average operative time was 263 minutes. 70% of the reductions were graded excellent, 22% were graded good, and 8% poor. One patient (2%) had a vascular injury requiring embolization. One patient (2%) had a wound infection in the lateral window, and one patient (2%) had atrophy and denervation of the ipsilateral rectus abdominus but no hernia. Clinical outcome (Merle D’Aubigne) at 1 year was 36% excellent, 55% good, and 10% poor. 13 patients were noted to have significant weakness of the hip adductors postoperatively; all resolved and improved within 6 months.
Conclusion: The modified Rives-Stoppa is a good alternative to the ilioinguinal for the anterior approach to the acetabulum. The approach affords the opportunity of achieving a good reduction while obviating the need for dissection and repair of the inguinal ligament and canal. Our single-surgeon series using the modified Rives-Stoppa approach demonstrates a similar complication rate to that reported by Letournel and Judet for the ilioinguinal approach.
Significance: Use of the modified Rives-Stoppa approach for the treatment of acetabular fractures permits good to excellent reduction in the majority of cases while giving superior access to and visualization of the quadrilateral plate and posterior column. This approach necessitates a less extensive surgical dissection and exposure and has a complication rate comparable to the ilioinguinal approach. We recommend the use of this technique as an alternative to the classical ilioinguinal approach when anterior exposure of the acetabulum is required.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.