gms | German Medical Science

Objectives: Alternatively to the modified Stoppa approach, the Pararectus approach is used clinically for treatment of acetabular fractures. This study assessed the surgical exposure and the options for instrumentation using both of these approaches.

Methods: Dissections were conducted on five human cadavers (male, mean age 88 years (82 to 97)) using modified Stoppa and Pararectus approach (same skin incision length 10cm). Distal boundaries of the exposed surfaces were marked using a chisel, soft-tissues removed and distances from the boundaries in the false and true pelvis were measured (reference: pelvic brim). Exposed bone was coloured, calibrated digital images of each inner hemipelvis were taken. The amount of exposed surface using both approaches was assessed and represented as a percentage of the total bony surface of each hemipelvis. For instrumentation, a suprapectineal plate was used. Screw lengths were documented, screw trajectories were assessed by three-dimensional CT. Wilcoxon's signed rank test for paired groups was used (level of significance: p<0.05).

Results and Conclusion: Percentage (mean±SD) of exposed bone accessible after utilizing the Pararectus approach was 42±8% versus 29±6% using the modified Stoppa (p=0.011). By use of the Pararectus approach, screws placed for posterior fixation and as a posterior column screw were longer by factor 1.8 and 2.1, respectively (p<0.05), could be placed more posteromedial towards the posterior inferior iliac spine or the ischial tuberosity. Compared to the modified Stoppa, the Pararectus approach facilitates a greater surgical access in the false pelvis, provides versatility for fracture fixation in the posterior pelvic ring and allows for the option to extend the approach without a new incision.