Accepted Manuscript Title: Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa Authors: J.D. Bastian MD M. Savic MD J.L. Cullmann W.D. Zech MD V. Djonov MD M.J. Keel MD, FACS PII: DOI: Reference:
S0020-1383(16)00047-4 http://dx.doi.org/doi:10.1016/j.injury.2016.01.025 JINJ 6584
To appear in:
Injury, Int. J. Care Injured
Received date: Revised date: Accepted date:
29-7-2015 20-11-2015 22-1-2016
Please cite this article as: Bastian JD, Savic M, Cullmann JL, Zech WD, Djonov V, Keel MJ, Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa., Injury (2016), http://dx.doi.org/10.1016/j.injury.2016.01.025 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa. 1,2
Bastian JD, 2Savic M, 3Cullmann JL, 4Zech WD, 2Djonov V, 1Keel MJ
1
Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
2
ip t
Institute of Anatomy, University of Bern, Switzerland
3
Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Switzerland
4
cr
Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Switzerland
Dr. med. Johannes Dominik BASTIAN, MD
us
Department of Orthopaedic and Trauma Surgery
University of Bern, Inselspital, Freiburgstrasse 3, 3010 Bern, Switzerland
an
Mirjana SAVIC, MD Institute of Anatomy
M
University of Bern, Switzerland Dr. med. Jennifer L. CULLMANN, MD
d
Institute for Diagnostic, Interventional and Paediatric Radiology
te
University of Bern, Inselspital, Freiburgstrasse 3, 3010 Bern, Switzerland
Dr. med. Wolf Dieter ZECH, MD
Ac ce p
Institute of Forensic Medicine, Department of Forensic Medicine and Imaging University of Bern, Switzerland
Prof. Dr. med. Valentin DJONOV, MD Institute of Anatomy
University of Bern, Switzerland
Prof. Dr. med. Marius Johann Baptist KEEL, MD, FACS Department of Orthopaedic and Trauma Surgery University of Bern, Inselspital, Freiburgstrasse 3, 3010 Bern, Switzerland
Page 1 of 37
Corresponding Author: Dr. med. Johannes Dominik BASTIAN, MD Department of Orthopedic and Trauma Surgery, University of Bern, Inselspital Freiburgstrasse 3
Tel
+41 (0)31 632 2111
Fax
+41 (0)31 632 3600
ip t
3010 Bern, Switzerland
Ac ce p
te
d
M
an
us
cr
Email: [email protected]
Page 2 of 37
Surgical exposures and options for instrumentation in acetabular fracture
Ac ce p
te
d
M
an
us
cr
ip t
fixation: Pararectus approach versus the modified Stoppa.
Page 3 of 37
ABSTRACT Background: As an alternative to the modified Stoppa approach, the Pararectus
ip t
approach is used clinically for treatment of acetabular fractures involving the anterior column. The current study assessed the surgical exposure and the options for
cr
instrumentation using both of these approaches. Methods: Surgical dissections were conducted on five human cadavers (all male, mean age 88 years (82 to 97)) using
us
the modified Stoppa and the Pararectus approach, with the same skin incision length
an
(10cm). Distal boundaries of the exposed bony surfaces were marked using a chisel. After removal of all soft-tissues, distances from the boundaries in the false and true
M
pelvis were measured with reference to the pelvic brim. The exposed bone was coloured and calibrated digital images of each inner hemipelvis were taken. The
d
amount of exposed surface using both approaches was assessed and represented
te
as a percentage of the total bony surface of each hemipelvis. For instrumentation, a suprapectineal quadrilateral buttress plate was used. Screw lengths were
Ac ce p
documented, and three-dimensional CT reconstructions were performed to assess screw trajectories qualitatively. Wilcoxon’s signed rank test for paired groups was used (level of significance: p
S0020-1383(16)00047-4 http://dx.doi.org/doi:10.1016/j.injury.2016.01.025 JINJ 6584
To appear in:
Injury, Int. J. Care Injured
Received date: Revised date: Accepted date:
29-7-2015 20-11-2015 22-1-2016
Please cite this article as: Bastian JD, Savic M, Cullmann JL, Zech WD, Djonov V, Keel MJ, Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa., Injury (2016), http://dx.doi.org/10.1016/j.injury.2016.01.025 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa. 1,2
Bastian JD, 2Savic M, 3Cullmann JL, 4Zech WD, 2Djonov V, 1Keel MJ
1
Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
2
ip t
Institute of Anatomy, University of Bern, Switzerland
3
Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Switzerland
4
cr
Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Bern, Switzerland
Dr. med. Johannes Dominik BASTIAN, MD
us
Department of Orthopaedic and Trauma Surgery
University of Bern, Inselspital, Freiburgstrasse 3, 3010 Bern, Switzerland
an
Mirjana SAVIC, MD Institute of Anatomy
M
University of Bern, Switzerland Dr. med. Jennifer L. CULLMANN, MD
d
Institute for Diagnostic, Interventional and Paediatric Radiology
te
University of Bern, Inselspital, Freiburgstrasse 3, 3010 Bern, Switzerland
Dr. med. Wolf Dieter ZECH, MD
Ac ce p
Institute of Forensic Medicine, Department of Forensic Medicine and Imaging University of Bern, Switzerland
Prof. Dr. med. Valentin DJONOV, MD Institute of Anatomy
University of Bern, Switzerland
Prof. Dr. med. Marius Johann Baptist KEEL, MD, FACS Department of Orthopaedic and Trauma Surgery University of Bern, Inselspital, Freiburgstrasse 3, 3010 Bern, Switzerland
Page 1 of 37
Corresponding Author: Dr. med. Johannes Dominik BASTIAN, MD Department of Orthopedic and Trauma Surgery, University of Bern, Inselspital Freiburgstrasse 3
Tel
+41 (0)31 632 2111
Fax
+41 (0)31 632 3600
ip t
3010 Bern, Switzerland
Ac ce p
te
d
M
an
us
cr
Email: [email protected]
Page 2 of 37
Surgical exposures and options for instrumentation in acetabular fracture
Ac ce p
te
d
M
an
us
cr
ip t
fixation: Pararectus approach versus the modified Stoppa.
Page 3 of 37
ABSTRACT Background: As an alternative to the modified Stoppa approach, the Pararectus
ip t
approach is used clinically for treatment of acetabular fractures involving the anterior column. The current study assessed the surgical exposure and the options for
cr
instrumentation using both of these approaches. Methods: Surgical dissections were conducted on five human cadavers (all male, mean age 88 years (82 to 97)) using
us
the modified Stoppa and the Pararectus approach, with the same skin incision length
an
(10cm). Distal boundaries of the exposed bony surfaces were marked using a chisel. After removal of all soft-tissues, distances from the boundaries in the false and true
M
pelvis were measured with reference to the pelvic brim. The exposed bone was coloured and calibrated digital images of each inner hemipelvis were taken. The
d
amount of exposed surface using both approaches was assessed and represented
te
as a percentage of the total bony surface of each hemipelvis. For instrumentation, a suprapectineal quadrilateral buttress plate was used. Screw lengths were
Ac ce p
documented, and three-dimensional CT reconstructions were performed to assess screw trajectories qualitatively. Wilcoxon’s signed rank test for paired groups was used (level of significance: p
