The Anterior Intra-Pelvic (Modified Rives-Stoppa) Approach for Fixation of Acetabular Fractures

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Abstract

Objectives:

Report the technical aspects, radiographic results, and complications after minimum 1-year follow up of the anterior intra-pelvic (AIP or modified Rives-Stoppa) approach as an alternative to the ilioinguinal approach for the treatment of acetabular fractures.

Design:

Retrospective review.

Setting:

Level I trauma center.

Materials and Methods:

All skeletally mature patients requiring an anterior approach for fixation of an acetabular fracture with minimum 1-year clinical and radiographic follow up were included. Charts and radiographs were reviewed for fracture pattern, time to surgery, operative time, blood loss, quality of reduction, and perioperative complications. A consecutive group of 57 patients treated by a single surgeon using the AIP approach was identified as a subset of a larger series 536 acetabular fractures treated by the same surgeon between February 2004 and February 2008.

Results:

Of the 57 patients, average time to operation was 5 days and a supplemental lateral window was required in 34 patients (60%). Average blood loss was 750 mL, and average operative time was 263 minutes. One patient (1.8%) had a vascular injury requiring embolization. One patient (1.8%) had a wound infection in the lateral window, two patients (3.5%) developed a direct inguinal hernia requiring surgical repair, and one patient (1.8%) had atrophy of the ipsilateral rectus abdominus without hernia. Of the 50 patients with minimum 1-year follow up, there were 22 associated both column, 12 anterior column, seven anterior column posterior hemitransverse, six transverse, and three T-type fractures. Seventy percent of the reductions were graded excellent, 22% were graded good, and 8% poor. Clinical outcomes (Merle D'Aubigne) at 1 year were 36% excellent, 55% good, and 10% poor. Thirteen patients (26%) were noted to have significant weakness of the hip adductors (obturator nerve palsy) postoperatively; all but one resolved and improved within 6 months.

Conclusion:

Use of the AIP (modified Rives-Stoppa) approach for the treatment of acetabular fractures permits good to excellent reduction in the majority of cases while giving excellent visualization and access to the quadrilateral plate and posterior column. The AIP approach has a complication rate that is comparable to the ilioinguinal approach. We recommend the use of this technique as a potential alternative (but not replacement) to the classic ilioinguinal approach when anterior exposure of the acetabulum is required.

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