Outcome for Patients with Acetabular Fractures Treated Using Only Modified Stoppa Approach or in Combination with...

PURPOSE OF THE STUDY This retrospective study presents our experience in treatment of polytrauma patients with acetabular fractures treated with only modified Stoppa approach or in combination with iliac wing approach. The purpose of this study was to evaluate the outcome of polytrauma patients with acetabular fractures operated with only modified Stoppa approach or in combination with iliac wing approach. MATERIAL AND METHODS Polytrauma patients who suffered from acetabular fractures treated in our hospital during 2008-2018, operated by using only modified Stoppa or in combination with iliac wing approach, were included in the study. The patients were evaluated using Majeed score. Cases with hip replacement due to post-traumatic osteoarthritis (PTOA) were summarized. The study group was compared with control group, which was operated through ilioinguinal approach. RESULTS We examined 42 patients (12 women and 30 men; mean age 44 years). Anatomical or satisfactory fracture healing was achieved in 92% of the acetabular fractures. In the study group Majeed score was significantly better (p<0.05). Seven patients from the study group had hip replacement due to PTOA with following results - 5 patients (13%) with anatomical or satisfactory reduction and 2 patients (50%) with displacement more than 3 mm of all reductions of acetabular fractures. DISCUSSION In polytrauma patients, the risk of the development of severe PTOA is increased because of high-energy trauma impact and a satisfactory reduction of acetabulum does not always protect against severe PTOA with following necessity for total hip replacement. CONCLUSIONS Our experience with using the modified Stoppa approach and its combination with iliac wing approach shows that these techniques provide better fracture reduction, gain mostly good radiological and functional results, may decrease the risk of development of severe symptomatic hip PTOA and hip replacement in polytrauma patients with both column acetabular fractures. Our results suggest that unsatisfactory reduction of an acetabular fracture is a strong predictor of symptomatic severe PTOA, which is treated by using total hip arthroplasty. Key words: acetabulum, modified Stoppa approach, iliac wing approach, post-traumatic osteoarthritis.