الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Through the efforts of Judet and Letournel in the 1960s, surgical intervention with open reduction and internal fixation (ORIF) became the treatment of choice for displaced acetabular fractures. Conservative treatment leads to an unacceptably high frequency of secondary arthritis. The operative treatment of complex acetabular fractures is often difficult and technically demanding.
Planning of the approach to be used and methods of reduction and fixation are done based on the fracture patterns and displacement.
Depending on the approach used in treating acetabular fractures, they can be classified as fractures requiring anterior approaches (fractures with a main displacement in the anterior structures), fractures that can be treated with posterior approaches (fractures with a main displacement in the posterior structures) and also fracture patterns requiring combined or extensive approaches (fractures with a wide displacement in both structures).
If a single nonextensile approach can be used for acetabular fractures with significant anterior and posterior column displacement, it might reduce the complications associated with the combined and extensile approaches.
The extensile and combined approaches are thought to be associated with higher rates of wound complications and morbidity. The more limited approaches are therefore theorized to be clinically advantageous.
The focus of our study is on the fractures that have both the anterior and posterior columns involved, to see whether it can be managed only with the modified Stoppa approach to save the patients from the complications of the extensile and combined approaches.
In our study, 20 patients with acetabular fractures involving both the anterior and posterior columns were managed with the modified Stoppa approach. Radiological (Matta’s radiological principles) and clinical (modified Merle d’Aubigné-Postel Score) assessments were done to them within a follow up duration with a mean of 12.8 months (range 10-18 months(.
The results were very encouraging, we reached an anatomical reduction in (75%), congruent reduction in (20%) and incongruent reduction in (5%). Regarding the functional outcome, 70% of cases had an excellent score, 25% had Good and 5% had Fair.
No intaoperative complications happened, with a mean time of operation 1.83±0.37 hours, and blood loss 427.5±54.95 ml. only one patient experienced a postoperative complication with a deep infection.
Those results came us with a conclusion that the modified Stoppa approach can access the posterior column and it also allows for anatomical reduction and fixation to be carried out much more easily.
The modified Stoppa approach used in this study allows direct visualization of:
• The entire pelvic brim from the pubic body to the anterior aspect of the sacroiliac joint.
• Quadrilateral plate allowing for reduction and plating.
• The posterior column from the greater sciatic notch to the ischial spine allowing reduction and plating.
But, that cannot be generalized, as there was a learning curve to reach those results, also the hazards of dealing with the surrounding vital anatomical structures. We must always respect the rule that the best approach is that the surgeon best knows.
Also, some fracture patterns were very difficult to deal with, especially the bicolumnar fractures and fractures with displaced comminuted posterior column.