Comparison between ilioinguinal approach and modified Stoppa approach for the treatment of acetabular fractures: An updated systematic review and meta-analysis

Background: The modified Stoppa (MS) approach is an alternative to the ilioinguinal (IL) approach andthree meta-analyses comparing these two approaches for the treatment of acetabular fractures werepublished previously. The aim of this study was to provide an updated systematic review and metaanalysis comparing the MS approach with the IL approach for the treatment of acetabular fractures andto answer the following question: are the results of the MS approach superior to those of the IL approachin terms of reduction quality, operative time, operative blood loss, complications, and clinical outcomesfor treatment of acetabular fractures? Patients and methods: An updated systematic literature review was conducted using relevant originalstudies from various databases (PubMed, Web of Science and the Cochrane Library). Pooling of data wasperformed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value of < 0.05was considered to be significant. We calculated the mean differences (MDs) for continuous data and oddsratio (OR) for dichotomous data with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed based on I-2 using the standard Chi(2) test. When I-2> 50%, significant heterogeneitywas assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model wasapplied in the absence of significant heterogeneity. Results: Six studies were included in this meta-analysis. The findings demonstrated that the rate ofanatomical reduction was significantly higher in the MS approach than in the IL approach (I-2= 0%, OR = 1.75, 95% CI: 1.13-2.69, p = 0.01), the operative time was significantly shorter in the MS approachthan in the IL approach (I-2= 88%, MD = -63.60, 95% CI: -93.01 - (-34.20), p < 0.0001) and operative bloodloss was significantly lower in the MS approach than in the IL approach (I-2= 75%, MD = -350.51, 95% CI: -523.45 - (-177.58), p < 0.0001). There was no significant difference in the rate of nerve injury (I-2= 0%, OR = 0.47, 95% CI: 0.16-1.39, p = 0.17), the rate of vascular injury (I-2= 0%, OR = 0.51, 95% CI: 0.17-1.49, p = 0.22), the rate of infection (I-2= 0%, OR = 0.53, 95% CI: 0.25-1.12, p = 0.10), the rate of heterotopic ossification (I-2= 45%, OR = 0.63, 95% CI: 0.22-1.85, p = 0.40), and the rate of excellent or good clinical score( I-2= 21%, OR = 1.15, 95% CI: 0.56-2.38, p = 0.70) between the two approaches. Discussion: The MS approach provided better reduction quality, shorter operative time, lower operativeblood loss, although there were no significant differences in the rate of complications, and excellent orgood clinical score between the two approaches. Level of evidence: III. (c) 2022 Elsevier Masson SAS. All rights reserved.

Automated summary

This study conducted a systematic review and meta-analysis of existing literature, and found that the modified Stoppa (MS) approach had better reduction quality, shorter operative time, and lower operative blood loss compared to the ilioinguinal (IL) approach for the treatment of acetabular fractures. However, there was no significant difference in complications and clinical outcomes between the two approaches.