RE: [ORT-L] Stoppa Approach Hints?


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RE: [ORT-L] Stoppa Approach Hints?

rahulbanerjee7 at hotmail
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Sep 27, 2007, 8:18 AM

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RE: [ORT-L] Stoppa Approach Hints?	Can't Post

For those of you that frequently utilize the Stoppa, modified Stoppa, or Stoppa in addition to the ilioinguinal approach, I have a few questions:

1. If you are utilizing the Stoppa window in addition to an ilioinguinal approach for a both column acetabular fracture, do you still develop Letournel's traditional middle window (between Psoas/Fem Nerve and Femoral A/V) , and if so, why?

2. I find it challenging to contour a plate along the interior aspect of the pelvic brim, and then more difficult to aim the screws appropriately. For example, if you contour the distal end of the plate so that it sits along the posterior aspect of the superior pubic ramus, it is often difficult to direct screws in this region due to the patient's abdomen. Similarly, screws placed at the very proximal portion of the plate (often near the SI joint) also come at a very sharp angle (directed posteriorly). Do any of you have any suggestions or tips that make this easier?

3. I have had two patients develop diffuse swelling of the entire lower extremity on the day after surgery. Both of these patients underwent ultrasound screening, DVT prophylaxis with Lovenox, and in both cases this resolved without incident. I assumed that these incidents may have been the result of prolonged retraction on the venous system or possible an undetected DVT. There was some discussion on the list just recently regarding vascular injuries, etc. using the Stoppa approach. Has anyone encountered anything similar? Does anyone have an explanations for what may cause this?

Thank you.

Rahul Banerjee, MD

mlroutt at u
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Sep 27, 2007, 11:34 AM

Post #2 of 3 (618 views)
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Re: [ORT-L] Stoppa Approach Hints? [In reply to]	Can't Post

See below

> For those of you that frequently utilize the Stoppa, modified Stoppa, or
> Stoppa in addition to the ilioinguinal approach, I have a few questions:
>
> 1. If you are utilizing the Stoppa window in addition to an ilioinguinal
> approach for a both column acetabular fracture, do you still develop
> Letournel's traditional middle window (between Psoas/Fem Nerve and Femoral
> A/V) , and if so, why?

Yes almost....but without dissection thru the external inguinal
ring...this area remains intact, but I do isolate and release the
iliopectineal fascia routinely...and I do so in order to use all of the
intervals.
>
> 2. I find it challenging to contour a plate along the interior aspect of the
> pelvic brim, and then more difficult to aim the screws appropriately. For
> example, if you contour the distal end of the plate so that it sits along the
> posterior aspect of the superior pubic ramus, it is often difficult to direct
> screws in this region due to the patient's abdomen. Similarly, screws placed
> at the very proximal portion of the plate (often near the SI joint) also come
> at a very sharp angle (directed posteriorly). Do any of you have any
> suggestions or tips that make this easier?
>
> Use a 3.5mm short drill to shape the plate hole obliquely to allow the
> obliquely aimed screw to pass thru and settle.
>
> 3. I have had two patients develop diffuse swelling of the entire lower
> extremity on the day after surgery. Both of these patients underwent
> ultrasound screening, DVT prophylaxis with Lovenox, and in both cases this
> resolved without incident. I assumed that these incidents may have been the
> result of prolonged retraction on the venous system or possible an undetected
> DVT. There was some discussion on the list just recently regarding vascular
> injuries, etc. using the Stoppa approach. Has anyone encountered anything
> similar? Does anyone have an explanations for what may cause this?
>
> No but I donšt retract for prolonged periods.
>
>
> chip
>
>
>
> Thank you.
>
>
>
> Rahul Banerjee, MD
>
>

M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--

mlroutt at u
New User

Sep 27, 2007, 11:54 AM

Post #3 of 3 (618 views)
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Re: [ORT-L] Stoppa Approach Hints? [In reply to]	Can't Post

The plate shaping with the 3.5mm drill is performed BEFORE insertion!!!!!

This process generates HEAT and metal debris....cool and wash the plate
before placing into the wound!!!

Chip

> See below
>
>
>
>
>> For those of you that frequently utilize the Stoppa, modified Stoppa, or
>> Stoppa in addition to the ilioinguinal approach, I have a few questions:
>>
>> 1. If you are utilizing the Stoppa window in addition to an ilioinguinal
>> approach for a both column acetabular fracture, do you still develop
>> Letournel's traditional middle window (between Psoas/Fem Nerve and Femoral
>> A/V) , and if so, why?
>
> Yes almost....but without dissection thru the external inguinal
> ring...this area remains intact, but I do isolate and release the
> iliopectineal fascia routinely...and I do so in order to use all of the
> intervals.
>>
>> 2. I find it challenging to contour a plate along the interior aspect of the
>> pelvic brim, and then more difficult to aim the screws appropriately. For
>> example, if you contour the distal end of the plate so that it sits along the
>> posterior aspect of the superior pubic ramus, it is often difficult to direct
>> screws in this region due to the patient's abdomen. Similarly, screws placed
>> at the very proximal portion of the plate (often near the SI joint) also come
>> at a very sharp angle (directed posteriorly). Do any of you have any
>> suggestions or tips that make this easier?
>>
>> Use a 3.5mm short drill to shape the plate hole obliquely to allow the
>> obliquely aimed screw to pass thru and settle.
>>
>> 3. I have had two patients develop diffuse swelling of the entire lower
>> extremity on the day after surgery. Both of these patients underwent
>> ultrasound screening, DVT prophylaxis with Lovenox, and in both cases this
>> resolved without incident. I assumed that these incidents may have been the
>> result of prolonged retraction on the venous system or possible an undetected
>> DVT. There was some discussion on the list just recently regarding vascular
>> injuries, etc. using the Stoppa approach. Has anyone encountered anything
>> similar? Does anyone have an explanations for what may cause this?
>>
>> No but I donšt retract for prolonged periods.
>>
>>
>> chip
>>
>>
>>
>> Thank you.
>>
>>
>>
>> Rahul Banerjee, MD
>>
>>
>
>
> M.L. Chip Routt, Jr.,M.D.
> Professor-Orthopedic Surgery
> Harborview Medical Center
> 325 Ninth Avenue
> Box 359798
> Seattle, WA 98104-2499
> phone 206-731-3658
> FAX 206-731-3227

M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--

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