The Stoppa approach for acetabular fracture

Objective

Acetabular fractures pose a great surgical challenge for orthopedic trauma surgeons. We believe that the Stoppa approach with an iliac window extension, previously described as a modified Stoppa approach is adequate for the majority of acetabular fractures excluding those with predominant posterior wall involvement. In this paper we will present our experience in using the Stoppa approach, its indications, preparations, the detailed surgical approach, complications and the different tips used in this relatively modern approach.

Indications

All simple and combined fracture types that involve the anterior column of the pelvis including the quadrilateral plate.

Contraindications

Posterior wall or extensive posterior column involvement. Transverse and T-fractures with mainly posterior displacement.

Surgical technique

Suprapubic, intrapelvic approach, extending from the symphysis pubis anteriorly to the sacroiliac joint posteriorly. Superficial landmarks are identical to the Pfannenstiel approach, the rectus abdominis muscles are longitudinally dissected, the symphysis pubis is exposed and a sub-periosteal deep surgical dissection is carried out along the anterior column and the quadrilateral plate, and posteriorly toward the greater sciatic notch and the sacroiliac joint.

Results

In a 5-year review of 60 acetabular fractures that underwent open reduction and internal fixation using the modified Stoppa approach, there were 36% anterior column fractures, 28% both-column fractures, the rest being anterior column with posterior hemi transverse fractures, transverse and T-fractures. Any extension of the fracture to the iliac wing necessitated an additional lateral window (93% of cases). In cases with posterior displacement, an additional approach was utilized to address a posterior wall fracture. All fractures healed within 12?weeks. Mean Merle d’Aubigné score was 15.22. Postoperative radiological evaluation revealed anatomical reduction in 54% of the patients, satisfactory in 43%, and unsatisfactory in 3% of the patients. Overall there were 15?minor and major complications     

Transient complete somatotropin insufficiency. A retrospective study

Two groups of patients with short stature and a limitation in the growth hormone (GH) response (peaks of 10 mU/l or below in response to 2 stimuli) differed by their GH responses at puberty: normalisation in group 1 (12 patients) and lack of normalisation in group 2 (13 patients). The condition of the patients of group 1 appeared to be less severe as judged by their initial height deficiency, their growth velocity and their GH peaks. Sex steroid hormone priming tests were highly discriminative, especially for the GH response to insulin stimulation. Other pituirary hormone deficiencies were never found in group 1, but did occur in group 2. Finally the beneficial long term effect of hGH therapy was questionable in group 1 in that there was no difference between the final heights of the treated (n = 7) and the untreated (n = 5) patients.     

Bioavailability, biodistribution, and toxicity of BioZn-AAS(1): a new zinc source. comparative studies in rats

Food fortification with a proper zinc compound is an economic and effective strategy to prevent zinc deficiency. BioZn-AAS, a zinc gluconate stabilized with glycine, was compared with zinc sulfate (reference standard), zinc hydroxide, and zinc gluconate, all of them labeled with (65)Zn. This preclinical study was performed on Sprague-Dawley rats of both sexes, and the administered dose was 85 microg/kg of zinc. Bioavailability studies showed that absorption of BioZn-AAS was not statistically different than absorption from other sources in female rats (25.65% +/- 2.20% for BioZn-AAS, 28.24% +/- 4. 60% for ZnSO(4), 24.91% +/- 4.02% for Zn[OH](2), and 25.51% +/- 2. 70% for Zn-gluconate). In the case of the male rats, absorption of BioZn-AAS (27.97% +/- 4.20%) was higher (P<0.05) than that from the other compounds (23.15% +/- 2.90% for ZnSO(4), 22.62% +/- 3.90% for Zn[OH](2), and 22.30% +/- 3.90% for Zn-gluconate). Biodistribution studies demonstrated that the zinc from BioZn-AAS followed the same metabolic pathway as zinc from the other sources. Toxicity studies were performed with 50 female and 50 male rats. The value of oral lethal dose 50 (LD(50)) was 2000 mg/kg for female rats and 1900 mg/kg for male rats. Therefore, we conclude that BioZn-AAS has adequate properties to be considered a proper zinc compound for food fortification or dietary supplementation.     

Transitory leukemoid reaction with regressive clonal course in a mongoloid newborn infant

A neonate with Down's syndrome presented with partial blast infiltration that spontaneously regressed without relapse at age 6 months. Sequential cytogenetic studies of cells in blood and bone marrow initially showed presence of a clone with 46 chromosomes and reciprocal translocation of chromosomes 5 and 7. This clone and the hematologic abnormality later disappeared simultaneously. Two explanations may be suggested: a defect in the maturation of normal blasts due to abnormal environment in the bone marrow, or an intrinsic abnormality of hematopoietic cells. The case reported would favor the second hypothesis.     

Use of the trispan device to assist coil embolization of high-flow arteriovenous fistulas

The Trispan device is a new tool designed for use in the endovascular treatment of wide-neck aneurysms with coils. We describe another application of this device to control coil deposition and to prevent coil migration during transvenous occlusion of high-flow arteriovenous fistulas.