Update in Orthopaedics

Comparative aspects of ilioinguinal approach and its variants in the surgical treatment of acetabular fractures

Murzich A.E., Voronovich A.I., Beletskiy A.V.
Med. News Vol 8/2015; p 8-11.

Abstract - In this paper, we studied the results of the treatment of 53 patients with displaced acetabular and pelvic fractures after open reduction using the anterior approach. In the first group (35 patients) we performed the ilioinguinal approach by Letournel, in the second (18 patients) we used combination of Stoppa and iliac approaches. The technique of anterior approaches, features and possible risks have been described. The fractures fixation was carried out using reconstructive plates and screws. In the first group with two-column fractures the anatomic reposition by Matta was achieved in 63% of cases, satisfactory in 30% and unsatisfactory in 7% of cases. In the second group, the deterioration quality of reposition of the typical fractures as well as cases of paraarticular ossification was not detected. We believe that the possibility of combination of Stoppa and iliac approaches is less traumatic, which has a lower risk of complications and is the same effective as ilioinguinal approach. Keywords: acetabulum fractures, ilioinguinal approach, Stoppa and iliac approach, osteosynthesis.

Comment by Pavel Volotovski 
SICOT Associate Member & SICOT Newsletter Editorial Board Member - Minsk, Belarus

Fractures of the acetabulum are one of the most difficult conditions to manage in orthopaedic surgery. The ability to reduce fragments anatomically is dependent on the ability of the surgeon to have exposure of the surgical field and, of course, it is determined by the surgical approach. The authors raised a highly curious issue and tried to find out if their combined approach could be at least non-inferior to the ilioinguinal approach.

The proposed single-stage combination of the two approaches (iliac and Stoppa) instead of ilioinguinal provided sufficient visualisation of the front parts of the pelvis and acetabulum, and did not require the separation of the neurovascular bundle. The surgical field reduction did not hamper the repositioning and fixation of fractures, but the author stated that it reduces the risk of intraoperative complications, promotes optimal healing of surgical wounds and early rehabilitation.

Currently, orthopaedic surgeons have no consensus about the approaches to be chosen in one or another situation in patients with acetabular fractures. However, the results of this study are consistent with the recent meta-analysis by Meena et al [1], who concluded that acetabular fractures operated with the modified Stoppa approach achieve better anatomic reduction and low complication rate as compared to the ilioinguinal approach in 375 patients taken from controlled trials from PubMed, EMBASE and Cochrane registry.

  1. Meena S, Sharma PK, Mittal S, Sharma J, Chowdhury B. Modified Stoppa Approach versus Ilioinguinal Approach for Anterior Acetabular Fractures; A Systematic Review and Meta-Analysis. Bull Emerg Trauma. 2017;5(1):6-12.