The modified Stoppa approach for acetabular fracture.

Judet et al and Letournel and Judet laid the groundwork for the current understanding and management of acetabular fractures. They developed a classification system and novel surgical approaches that still serve as the standard of care. Modifications of these approaches (eg, ilioinguinal, Kocher-Langenbeck) have been developed to improve surgical outcomes. The Stoppa approach is used in the repair of inguinal hernias. Hirvensalo et al and Cole and Bolhofner described a modified Stoppa approach involving an anterior intrapelvic (AIP) extraperitoneal approach through the rectus abdominis muscle for internal fixation of pelvic and acetabular fractures. This approach provides direct access to the pubis, the posterior surface of the ramus, the quadrilateral surface, the pubic eminence, and the infrapectineal surface, as well as the sciatic buttress, sciatic notch, and the anterior sacroiliac joint. The modified Stoppa (ie, AIP) approach provides improved exposure of the quadrilateral surface and posterior column. Additionally, with the AIP approach, the so-called middle window of the ilioinguinal approach can frequently be avoided, resulting in minimal dissection of the inguinal canal, femoral nerve, and external iliac vessels.