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Posterior column acetabular fractures treated through the modified Stoppa approach: Clinical and radiological
Dharmendra Kumar1, Balwinder Singh2, Sujeet Kumar Chaudhary1
1Department of Orthopaedic Surgery, King George's Medical University, Shah Mina Rd, Chowk, Lucknow, Uttar Pradesh, 226003, India.
Background:
Acetabular fractures with posterior column involvement are traditionally managed with fixation strategies that may include medial buttress plating, particularly in fractures with quadrilateral plate involvement. However, the necessity of routine medial buttress support remains debated. With the evolution of intrapelvic approaches, especially the modified Stoppa approach, stable fixation may be achievable without additional medial buttress plating in selected fracture patterns. This study evaluates the clinical and radiological outcomes of posterior column acetabular fractures treated via an anterior intrapelvic approach without routine medial buttress plating.
Methods:
A retrospective analysis was conducted on patients with posterior column acetabular fractures managed surgically using the modified Stoppa approach over a defined study period. Patients with associated fracture patterns involving the quadrilateral plate were included. Fixation was achieved using reconstruction plates with or without lag screws, without the routine use of medial buttress plates. Clinical outcomes were assessed using functional scoring systems, while radiological outcomes were evaluated based on quality of reduction and progression to post-traumatic arthritis. Complications and reoperation rates were also recorded.
Results:
Anatomical or near-anatomical reduction was achieved in the majority of cases. Functional outcomes were predominantly good to excellent at final follow-up. The incidence of post-traumatic arthritis was 23.52%, with higher rates observed in patients with delayed presentation and more complex fracture patterns. No significant increase in medial displacement or fixation failure was noted despite omission of medial buttress plating. Complication rates were comparable to existing literature.
Conclusion:
The modified Stoppa approach provides effective exposure and stable fixation for posterior column acetabular fractures. Routine medial buttress plating may not be necessary in all cases, particularly when adequate fracture reduction and stable fixation are achieved. However, its use should be considered in highly comminuted or osteoporotic fractures. Careful patient selection remains essential.
