Open Reduction of Geriatric Acetabulum Fractures Using a Stoppa Exposure

Geriatric acetabular fractures pose unique challenges to the orthopedic trauma surgeon. A common insufficiency fracture pattern includes femoral head medialization through quadrilateral plate fracture. Adequate reduction and fixation of this unstable fracture pattern can be quite difficult. The Stoppa exposure, however, allows for excellent access to the intrapelvic portion of acetabulum. Fracture of the medialized quadrilateral plate can be directly reduced and buttressed with internal fixation using an infrapectineal plate. This technique is heralded for the limited dissection and surgical morbidity compared with traditional acetabular exposures/techniques. However, this approach limits access to the anterior or posterior columns of the acetabulum, and surgical pitfalls include the potential for neurovascular and bladder injury.