Pararectus approach better than modified stoppa approach for treating complex pelvic and acetabular fractures

Pelvic and acetabular fractures are common orthopedic diseases. Wei Liu et al conducted a study to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures. The study has been published in Indian Journal of Orthopaedics.

The authors found that the pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures.

The clinical information of patients with pelvic and acetabular fractures treated surgically in Luan Hospital of Chinese medicine, China for a period of 4 years was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared.

Key findings of the study were:

•The patients were followed up for 6–7 months (average, 6.5 months).

•The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180±41.105 min, 8.667±1.373 cm, 259.667±382 mL and 202.667±32.793 min, 11.600±1.958 cm, and 353.667±590 mL, respectively.

•The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively.

•There were significant differences in operation time, incision length, and blood loss between the two groups (p<0.05).

•There was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p>0.05).

The authors commented that – "the results showed that the operation time, incision length, and blood loss of the pararectus approach group were significantly better than those of the modified Stoppa approach. Besides, the pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. So all these results furtherly confirmed the important application values of the pararectus approach in the surgical treatment of complex pelvic acetabular fractures. It is expected that this approach will be more widely used in the clinical treatment of pelvic and acetabular fractures in the future."

For steps of pararectus approach and details please refer to:

Comparison of Therapeutic Outcomes of Transabdominal Pararectus Approach and Modifed Stoppa Approach in Treating Pelvic and Acetabular Fractures Wei Liu, Hongbin Yang et al Indian Journal of Orthopaedics (2022) 56:829–836 https://doi.org/10.1007/s43465-021-00585-1