Ilioinguinal approach versus Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures: A systematic review and meta-analysis

Abstract

Purpose: To compare the efficacy and safety of open reduction and internal fixation through ilioinguinal approach and Stoppa approach for the treatment of displaced acetabular fractures.

Methods: Case-controlled trials (CCTs) published from January 2010 to August 2015 that compared the ilioinguinal approach and Stoppa approach in the management of displaced acetabular fractures were retrieved from the databases of Cochrane Library, Pubmed, CNKI, and so on. Methodological quality of the trials was critically assessed. Statistical software RevMan 5.0 was used for data analysis.

Results: Eight articles were included in the meta-analysis. Through comparing the efficacy and safety of ilioinguinal approach and Stoppa approach in the treatment of displaced acetabular fracture, statistical significance was found in the average operation time [WMD = 68.29, 95% CI (10.52, 126.05), p < 0.05] and the median intraoperative blood loss [WMD = 142.26, 95% CI (9.30, 275.23), p < 0.05]. However, there existed no statistical significance in the fracture end reset satisfaction rate [RR = 0.63, 95% CI (0.17, 2.37), p > 0.05], the early complications rate [RR = 0.89, 95% CI (0.33, 2.40), p > 0.05], the late complications rate [RR = 0.91, 95% CI (0.27, 3.01), p > 0.05], and Harris hip score good function rate [RR = 0.52, 95% CI (0.25, 1.10), p > 0.05].

Conclusion: Though both techniques can obtain satisfactory clinical functions in the treatment of displaced acetabular fractures, Stoppa approach is superior to the ilioinguinal approach in terms of operation time and intraoperative blood loss.

Keywords: Displaced acetabular fractures; Ilioinguinal approach; Meta-analysis; Stoppa approach.

Fig. 1

Flow diagram of the study selection process.

Fig. 2

The forest plot of the average operation time between two groups.

Fig. 3

The forest plot of the median intraoperative blood loss between two groups.

Fig. 4

The forest plot of the rate of fracture end reset satisfaction between two groups.

Fig. 5

The forest plot of the early complications rate between two groups.

Fig. 6

The forest plot of the late complications rate between two groups.

Fig. 7

The forest plot of the rate of HHS good function rate between two groups.

Fig. 8

The funnel figures of the evaluation projects. A: average operation time, B: the median intraoperatie blood loss, C: fracture end reset satisfaction, D: the early complications rate, E: the late complications rate, F: HHS good function rate.

Fig. 9

Risk of bias. Each risk of bias item is presented as a percentage across all included studies and indicates the proportional level for each risk of bias item.

Fig. 10

Methodological quality of the included studies. This risk of bias tool incorporates assessment of randomization (sequence generation and allocation concealment), blinding (participants, personnel and outcome assessors), completeness of outcome data, selection of outcomes reported and other sources of bias. The items were scored with ‘‘yes’’, ‘‘no’’, or ‘‘unsure’’.