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European Journal of Orthopaedic Surgery & Traumatology

07-03-2024 | Acetabular Fracture | General Review

Does the pararectus approach have better outcomes and fewer complications than the modified Stoppa approach for the fixation of acetabular fractures in adults: A systematic review and meta-analysis?

Authors: Rajesh Kumar Rajnish, Abhay Elhence, Amit Srivastava, Sandeep Kumar Yadav, Prabodh Kantiwal, Saurabh Gupta

Published in: European Journal of Orthopaedic Surgery & Traumatology

Abstract

Background

The pararectus approach is a minimally invasive surgical approach for anterior acetabulum fracture, with an advantage of the medial window of the modified Stoppa approach (MSA). However, it is unclear whether the pararectus approach is superior to MSA. We aimed this systematic review and meta-analysis to compare the outcomes and complications of pararectus and MSA.

Methods

We performed a data search by conducting an electronic search across databases of PubMed, Embase, Scopus, Cinahl, CNKI, and Cochrane Library and included seven comparative studies for analysis. Statistical analysis was performed using the RevMan software 5.4.1. The risk of bias was evaluated using the Cochrane Collaboration’s risk of bias tool for RCTs and the MINORS tool for non-RCTs.

Results

Two randomized control trials (RCTs), one prospective study, and four retrospective studies were included. Meta-analysis revealed a better Matta’s reduction quality [OR 1.58, 95% CI 1.06, 2.37; p = 0.03] and radiological outcome [OR 2.18, 95% CI 1.03, 4.60; p = 0.04] in MSA than in pararectus approach. However, the pararectus approach has less intraoperative blood loss [MD – 9.79 (95% CI − 176.75, − 6.83; p = 0.03)] and a shorter hospital stay [MD − 2.61 (95% CI − 5.03, − .18; p = 0.04)] than MSA. Both approaches have failed to show a difference concerning overall complication rates [OR 0.66 (95% CI 0.28, 1.55; p = 0.34)], postoperative infection, DVT, duration of surgery [MD − 15.09 (95% CI − 35.38, 5.20; p = 0.15)], functional outcome, and incision length.

Conclusion

The pararectus approach offers an advantage with lesser operative blood loss and shorter hospital stay, whilst MSA stands out with better reduction quality and radiological outcomes. Nevertheless, both approaches exhibit no difference in complication rates, duration of surgery, incision length, and functional outcome. Hence, the pararectus approach can be considered an alternative to MSA; however, the existing literature fails to demonstrate a distinct advantage over MSA.

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Title: Does the pararectus approach have better outcomes and fewer complications than the modified Stoppa approach for the fixation of acetabular fractures in adults: A systematic review and meta-analysis?
Authors: Rajesh Kumar Rajnish
Abhay Elhence
Amit Srivastava
Sandeep Kumar Yadav
Prabodh Kantiwal
Saurabh Gupta
Publication date: 07-03-2024
Publisher: Springer Paris
Keywords: Acetabular Fracture
Incision
Published in: European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-024-03885-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does the pararectus approach have better outcomes and fewer complications than the modified Stoppa approach for the fixation of acetabular fractures in adults: A systematic review and meta-analysis?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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