Modified Stoppa Approach for ORIF of a Paediatric Transverse Acetabular Fracture: Case Report and Systematic Review of Internal Fixation in Children

TL;DR

A modified Stoppa surgical approach successfully treated a complex acetabular fracture in an 11-year-old, with good recovery outcomes and a review showing ORIF can be effective in children when done properly.

Contribution

Demonstrates the modified Stoppa approach's feasibility in skeletally immature patients with complex acetabular fractures, supported by a systematic review of existing literature.

Findings

An 11-year-old achieved excellent recovery after ORIF via a modified Stoppa approach for a transverse acetabular fracture.

Systematic review of 16 studies found good-to-excellent outcomes in pediatric acetabular fractures when anatomical reduction and stable fixation are achieved.

Current evidence is limited and heterogeneous, making it difficult to recommend a single optimal surgical approach for children.

Abstract

What are the main findings?
An 11-year-old with a transverse acetabular fracture involving disruption of the triradiate cartilage was successfully treated with ORIF via a modified Stoppa approach, achieving excellent six-month functional recovery (return to daily activities and sport).A systematic review of 16 studies of the literature shows that paediatric acetabular fractures treated with ORIF generally have good-to-excellent outcomes when the criteria for surgical treatment are met, and when anatomical reduction and stable fixation are obtained.

An 11-year-old with a transverse acetabular fracture involving disruption of the triradiate cartilage was successfully treated with ORIF via a modified Stoppa approach, achieving excellent six-month functional recovery (return to daily activities and sport).

A systematic review of 16 studies of the literature shows that paediatric acetabular fractures treated with ORIF generally have good-to-excellent outcomes when the criteria for surgical treatment are met, and when anatomical reduction and stable fixation are obtained.

What are the implications of the main findings?
The modified Stoppa approach—commonly used in adults—appears to be a safe, effective option in selected skeletally immature patients with fractures involving the anterior column/quadrilateral surface, even when the triradiate cartilage is affected.Evidence in the literature is limited, and heterogeneous, careful case selection and timely anatomical reduction are crucial, and current evidence remains insufficient to make firm, general recommendations on the optimal paediatric surgical approach.

The modified Stoppa approach—commonly used in adults—appears to be a safe, effective option in selected skeletally immature patients with fractures involving the anterior column/quadrilateral surface, even when the triradiate cartilage is affected.

Evidence in the literature is limited, and heterogeneous, careful case selection and timely anatomical reduction are crucial, and current evidence remains insufficient to make firm, general recommendations on the optimal paediatric surgical approach.

Background: Paediatric pelvic and acetabular fractures are rare and usually the consequence of high-energy trauma, often associated with life-threatening injuries. The majority are managed non-operatively; however, open reduction and internal fixation (ORIF) is indicated in selected, complex, or displaced, acetabular fractures. The modified Stoppa approach is well established in adults, but has been rarely reported in skeletally immature patients, and evidence guiding surgical approach and fixation in children remains limited. Methods: We report the case of an 11-year-old girl who sustained a transverse acetabular fracture following a high-energy trauma. The fracture was treated with ORIF through a modified Stoppa approach. We also performed a systematic review of the literature, focusing on ORIF of acetabular fractures in children. Results: In our patient, ORIF of the acetabular fracture was performed, achieving an anatomical reduction, 10 days after initial damage-control fixation of a concomitant open tibial plateau fracture. Postoperative management consisted of four weeks of non-weight bearing, followed by progressive weight bearing. At six months, she had returned to full daily activities and sports. The review of the literature identified 16 studies (retrospective series and case reports) describing paediatric acetabular fractures treated with ORIF using plates, screws, or flexible nails. In the literature, good to excellent clinical and radiographic outcomes were reported when anatomical reduction and stable fixation were achieved, although growth disturbance and avascular necrosis were described, particularly in cases with delayed reduction or severe triradiate cartilage injury. Conclusions: Our case illustrates the technical feasibility of the modified Stoppa approach in a skeletally immature patient with a complex acetabular fracture, with excellent mid-term outcome. Although it is not contraindicated in paediatric patients, it should be reserved for treating this type of complex fracture. The available literature supports that satisfactory results are reported after ORIF in children, but the heterogeneity and low level of evidence preclude firm recommendations on the optimal approach.

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