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Modified Stoppa Approach for ORIF of a Paediatric Transverse Acetabular Fracture: Case Report and Systematic Review
Massimo Berdini1, Roberto Procaccini1, Donato Carola1
1Department of Clinical and Molecular Sciences, Clinica Ortopedica dell'Adulto e Pediatrica, Università Politecnica delle Marche, 60126 Ancona, Italy.
Insights
Open reduction and internal fixation (ORIF) using the modified Stoppa approach is feasible for complex paediatric acetabular fractures. This technique, though rarely reported in children, offers excellent mid-term outcomes, but evidence for optimal paediatric fracture management remains limited.
Area of Science:
- Orthopaedic Surgery
- Paediatric Traumatology
- Skeletal Biology
Background:
- Paediatric pelvic and acetabular fractures are rare, high-energy injuries.
- Surgical management (ORIF) is reserved for complex or displaced fractures.
- The modified Stoppa approach is established in adults but underreported in children, with limited evidence for paediatric use.
Purpose of the Study:
- To report a case of paediatric acetabular fracture treated with ORIF via a modified Stoppa approach.
- To systematically review the literature on ORIF for paediatric acetabular fractures.
Main Methods:
- Case report of an 11-year-old girl with a transverse acetabular fracture treated with ORIF.
- Systematic literature review of ORIF for paediatric acetabular fractures.
Main Results:
- The patient achieved anatomical reduction and excellent mid-term outcomes with the modified Stoppa approach.
- Literature review identified 16 studies reporting good to excellent outcomes with ORIF (plates, screws, nails).
- Complications like growth disturbance and avascular necrosis were noted, especially with delayed treatment or severe triradiate cartilage injury.
Conclusions:
- The modified Stoppa approach is technically feasible and effective for complex paediatric acetabular fractures.
- ORIF in children can yield satisfactory results, but evidence is limited.
- Further research is needed to establish optimal surgical approaches for paediatric acetabular fractures.
Background:
Paediatric pelvic and acetabular fractures are rare and usually the consequence of high-energy trauma, often associated with life-threatening injuries. The majority are managed non-operatively; however, open reduction and internal fixation (ORIF) is indicated in selected, complex, or displaced, acetabular fractures. The modified Stoppa approach is well established in adults, but has been rarely reported in skeletally immature patients, and evidence guiding surgical approach and fixation in children remains limited.
Methods:
We report the case of an 11-year-old girl who sustained a transverse acetabular fracture following a high-energy trauma. The fracture was treated with ORIF through a modified Stoppa approach. We also performed a systematic review of the literature, focusing on ORIF of acetabular fractures in children.
Results:
In our patient, ORIF of the acetabular fracture was performed, achieving an anatomical reduction, 10 days after initial damage-control fixation of a concomitant open tibial plateau fracture. Postoperative management consisted of four weeks of non-weight bearing, followed by progressive weight bearing. At six months, she had returned to full daily activities and sports. The review of the literature identified 16 studies (retrospective series and case reports) describing paediatric acetabular fractures treated with ORIF using plates, screws, or flexible nails. In the literature, good to excellent clinical and radiographic outcomes were reported when anatomical reduction and stable fixation were achieved, although growth disturbance and avascular necrosis were described, particularly in cases with delayed reduction or severe triradiate cartilage injury.
Conclusions:
Our case illustrates the technical feasibility of the modified Stoppa approach in a skeletally immature patient with a complex acetabular fracture, with excellent mid-term outcome. Although it is not contraindicated in paediatric patients, it should be reserved for treating this type of complex fracture. The available literature supports that satisfactory results are reported after ORIF in children, but the heterogeneity and low level of evidence preclude firm recommendations on the optimal approach.
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