Research Article
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A New Effective And Reliable Technique For Bleeding Control İn The Modified Stoppa Approach To Acetabulum Quadrilateral Region Fractures; Ligate The Obturator Artery

Year 2023, Volume: 7 Issue: 3, 267 - 273, 31.12.2023
https://doi.org/10.30565/medalanya.1394770

Abstract

Aim: This study aims to share the methods of managing foci that cause bleeding in the modified Stoppa approach to acetabulum quadrilateral region fractures. In addition, it is to reveal the amount of perioperative bleeding and the clinical effect of ligated arteries in patients whose surgery was performed with advanced bleeding control technique.

Patients and methods: Between May 1, 2020, and June 30, 2023, perioperative bleeding data of 13 patients with acetabulum quadrilateral region fractures operated on with a modified Stoppa approach and advanced bleeding control technique were evaluated retrospectively. Age, gender, fracture mechanism, fracture side, fracture type, amount of perioperative bleeding, and follow-up periods were determined. The clinical effect of ligated arteries was observed in the postoperative period. In the CT scans taken in the postoperative period, the diameters of the gluteal muscles and adductor muscles were compared to the healthy side.

Results: Of the 13 patients included in the study, 5 were women, and 8 were men. While the average age was 35.6 years, the average follow-up period was 15.3 months. The average number of sponges used during the modified Stoppa approach and the amount of bleeding measured with an aspirator was 284.2 ml. The middle area of the gluteal muscles compared to the healthy side was 0.89, while the average area of the adductor muscles was 0.89. No problems related to the ligated vessels were observed in any patient during the postoperative period and outpatient follow-up.

Conclusions: Routine ligation of the obturator artery does not have any clinically observable adverse effects, and with advanced bleeding control, it facilitates both the hemodynamic management of the patient in terms of anesthesia and the management of the surgical field for the surgeon.

Ethical Statement

In this study, national and international ethical rules are observed.

Supporting Institution

-

Thanks

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References

  • 1. Otto W. Azetabulumfrakturen. Diagnostik, Klassifikation, Bewertung [Acetabulum fractures. Diagnosis, classification, evaluation]. Zentralbl Chir. 2000;125(9):725-9. German. Doi: 10.1055/s-2000-10663. PMID: 11050752.
  • 2. Haas NP, Stöckle UC, Hoffmann R. Azetabulumchirurgie. Entwicklung, Stand und Ausblick [Acetabulum surgery. Development, current status, and prospects]. Zentralbl Chir. 1999;124(11):999-1003. German. PMID: 10612205.
  • 3. Elmadağ M, Güzel Y, Acar MA, Uzer G, Arazi M. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case-control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res. 2014 Oct;100(6):675-80. doi: 10.1016/j.otsr.2014.05.020.
  • 4. Sharma A, Das S, Kaganur R, Paul N, Pragadeeshwaran J, Khande CK, Kunwar BB. A Comparative Analysis of Commonly Used Surgical Approaches for Anterior Acetabular Fractures. Cureus. 2023 May 13;15(5):e38979. doi: 10.7759/cureus.38979.
  • 5. Biffl WL. Control of pelvic fracture-related hemorrhage. Surg Open Sci. 2022 Jan 26;8:23-26. doi: 10.1016/j.sopen.2022.01.001.
  • 6. Báča V, Marvanová Z, Štefela J, Hašplová K, Kachlík D, Džupa V. Riziko krvácení z arteria iliaca interna a jejích větví při zlomeninách pánve: kadaverózní studie [Risk of bleeding from the internal iliac artery and its branches in pelvic fractures: cadaver study]. Acta Chir Orthop Traumatol Cech. 2015;82(1):48-50. Czech. doi:10.55095/achot2015/006
  • 7. Sanna B, Henry BM, Vikse J, Skinningsrud B, Pękala JR, Walocha JA, Cirocchi R, Tomaszewski KA. The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery. Injury. 2018;49(2):302-308. doi: 10.1016/j.injury.2017.12.007.
  • 8. Heichinger R, Pretterklieber ML, Hammer N, Pretterklieber B. The Corona mortis is similar in size to the regular obturator artery but is highly variable at the level of origin: an anatomical study. Anat Sci Int. 2023;98(1):43-53. doi: 10.1007/s12565-022-00671-w.
  • 9. Elhence A, Gupta A. Corona Mortise- anatomical variants and implications in pelvic-acetabular surgery: An evidence-based review. J Orthop. 2023 Jan 28;37:9-14. Doi: 10.1016/j.jor.2023.01.011.
  • 10. Kwon H, Jang JH, Moon NH, Rhee SJ, Ryu DY, Ahn TY. Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single-center observational study. J Orthop Sci. 2023 Oct 20:S0949-2658(23)00279-8. doi: 10.1016/j.jos.2023.10.007.
  • 11. Leunig M, Meyer M, Beck M, Triller J, Stupnicki A, Zimmermann H. Fatal retroperitoneal hemorrhage caused by perforation of a guidewire pin for proximal femur fixation. Arch Orthop Trauma Surg. 2002;122(1):61-3. doi: 10.1007/s004020100350.
  • 12. Seeker LC, Bartlett CS. Management of Obturator Vessel Hemorrhage by Pubic Ramus Osteotomy During Acetabular Fixation-A Technical Trick. J Orthop Trauma. 2023 Oct 1;37(10):e416-e420. doi: 10.1097/BOT.0000000000002545.
  • 13. Vaidya R, Waldron J, Scott A, Nasr K. Angiography and Embolization in the Management of Bleeding Pelvic Fractures. J Am Acad Orthop Surg. 2018;26(4):e68-e76. doi: 10.5435/JAAOS-D-16-00600.
  • 14. Wadhwa H, Rohde M, Oquendo Y, Chen MJ, Tigchelaar SS, Bellino M et al. Interaction of preoperative chemoprophylaxis and tranexamic acid use does not affect transfusion in acetabular fracture surgery. Eur J Orthop Surg Traumatol. 2023 Oct 21. doi: 10.1007/s00590-023-03763-z.
  • 15. Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Banneyake EL, Gunasekera IS, Fang Y. A prophylactic TXA administration effectively reduces the risk of intraoperative bleeding during open management of pelvic and acetabular fractures. Sci Rep. 2023;13(1):12570. doi: 10.1038/s41598-023-39873-1.

Asetabulum Quadrilateral Bölge Kırıklarına Stoppa Yaklaşımda Kanama Kontrolünde Efektif Ve Güvenilir Yeni Bir Teknik; Obturatör Arteri Bağlamak

Year 2023, Volume: 7 Issue: 3, 267 - 273, 31.12.2023
https://doi.org/10.30565/medalanya.1394770

Abstract

Amaç: Bu çalışmanın amacı asetabulum quadrilateral bölge kırıklarına modifiye stoppa yaklaşımda kanamaya neden olan odakların yönetimi konusunda elde edilen çözüm metodlarını paylaşmaktır. Ayrıca ileri kanama kontrolü tekniği ile cerrahisi sağlanan hastaların perioperatif kanama miktarını ve bağlanan arterlerin klinik etkisini ortaya çıkarmaktır.

Hastalar ve yöntem: 1 Mayıs 2020-30 Haziran 2023 tarihleri arasında asetabulum quadrilateral bölge kırığına sahip, modifiye stoppa aproach ve ileri kanama kontrolü tekniği ile opere edilen 13 hastanın perioperatif toplanan kanama verileri geriye dönük olarak değerlendirildi. Yaş, cinsiyet, kırık mekanizması, kırık tarafı, kırık tipi, perioperatif kanama miktarı ve takip süreleri belirlendi. Postoperatif dönemde bağlanan arterlerin klinik etkisi gözlemlendi. Ameliyat sonrası dönemde çekilen bilgisayarlı tomografilerde gluteal kasların ve addüktör kasların çapları sağlıklı tarafla karşılaştırıldı.

Bulgular: Çalışmaya alınan 13 hastanın 5’i kadın iken 8’i erkek idi. Ortalama yaş 35,6 iken ortalama takip süresi 15,3 ay idi. Modifiye stoppa aproach esnasında kullanılan spanç sayısı ve aspiratör ile ölçülen kanama miktarı ortalama 284,2 cc olarak hesaplandı. Gluteal kasların sağlıklı tarafa göre ortalama alanı 0,89, adduktor kasların ortalama alanı ise 0,89 olarak belirlendi. Postoperatif dönemde ve poliklinik takiplerinde hiçbir hastada bağlanan damarlar kaynaklı problem gözlenmedi.

Sonuç: Obturatör arterin rutin bağlanmasının klinik olarak gözlenebilen bir olumsuz etkisi olmadığı gibi ileri kanama kontrolü ile hem anestezi açısından hastanın hemodinamik yönetimini, hem de cerrah açısından cerrahi alan yönetimini kolaylaştırmaktadır.

Ethical Statement

Bu çalışmada ulusal ve uluslararası etik kurallara uyulmuştur.

Supporting Institution

-

Thanks

-

References

  • 1. Otto W. Azetabulumfrakturen. Diagnostik, Klassifikation, Bewertung [Acetabulum fractures. Diagnosis, classification, evaluation]. Zentralbl Chir. 2000;125(9):725-9. German. Doi: 10.1055/s-2000-10663. PMID: 11050752.
  • 2. Haas NP, Stöckle UC, Hoffmann R. Azetabulumchirurgie. Entwicklung, Stand und Ausblick [Acetabulum surgery. Development, current status, and prospects]. Zentralbl Chir. 1999;124(11):999-1003. German. PMID: 10612205.
  • 3. Elmadağ M, Güzel Y, Acar MA, Uzer G, Arazi M. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: a case-control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res. 2014 Oct;100(6):675-80. doi: 10.1016/j.otsr.2014.05.020.
  • 4. Sharma A, Das S, Kaganur R, Paul N, Pragadeeshwaran J, Khande CK, Kunwar BB. A Comparative Analysis of Commonly Used Surgical Approaches for Anterior Acetabular Fractures. Cureus. 2023 May 13;15(5):e38979. doi: 10.7759/cureus.38979.
  • 5. Biffl WL. Control of pelvic fracture-related hemorrhage. Surg Open Sci. 2022 Jan 26;8:23-26. doi: 10.1016/j.sopen.2022.01.001.
  • 6. Báča V, Marvanová Z, Štefela J, Hašplová K, Kachlík D, Džupa V. Riziko krvácení z arteria iliaca interna a jejích větví při zlomeninách pánve: kadaverózní studie [Risk of bleeding from the internal iliac artery and its branches in pelvic fractures: cadaver study]. Acta Chir Orthop Traumatol Cech. 2015;82(1):48-50. Czech. doi:10.55095/achot2015/006
  • 7. Sanna B, Henry BM, Vikse J, Skinningsrud B, Pękala JR, Walocha JA, Cirocchi R, Tomaszewski KA. The prevalence and morphology of the corona mortis (Crown of death): A meta-analysis with implications in abdominal wall and pelvic surgery. Injury. 2018;49(2):302-308. doi: 10.1016/j.injury.2017.12.007.
  • 8. Heichinger R, Pretterklieber ML, Hammer N, Pretterklieber B. The Corona mortis is similar in size to the regular obturator artery but is highly variable at the level of origin: an anatomical study. Anat Sci Int. 2023;98(1):43-53. doi: 10.1007/s12565-022-00671-w.
  • 9. Elhence A, Gupta A. Corona Mortise- anatomical variants and implications in pelvic-acetabular surgery: An evidence-based review. J Orthop. 2023 Jan 28;37:9-14. Doi: 10.1016/j.jor.2023.01.011.
  • 10. Kwon H, Jang JH, Moon NH, Rhee SJ, Ryu DY, Ahn TY. Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single-center observational study. J Orthop Sci. 2023 Oct 20:S0949-2658(23)00279-8. doi: 10.1016/j.jos.2023.10.007.
  • 11. Leunig M, Meyer M, Beck M, Triller J, Stupnicki A, Zimmermann H. Fatal retroperitoneal hemorrhage caused by perforation of a guidewire pin for proximal femur fixation. Arch Orthop Trauma Surg. 2002;122(1):61-3. doi: 10.1007/s004020100350.
  • 12. Seeker LC, Bartlett CS. Management of Obturator Vessel Hemorrhage by Pubic Ramus Osteotomy During Acetabular Fixation-A Technical Trick. J Orthop Trauma. 2023 Oct 1;37(10):e416-e420. doi: 10.1097/BOT.0000000000002545.
  • 13. Vaidya R, Waldron J, Scott A, Nasr K. Angiography and Embolization in the Management of Bleeding Pelvic Fractures. J Am Acad Orthop Surg. 2018;26(4):e68-e76. doi: 10.5435/JAAOS-D-16-00600.
  • 14. Wadhwa H, Rohde M, Oquendo Y, Chen MJ, Tigchelaar SS, Bellino M et al. Interaction of preoperative chemoprophylaxis and tranexamic acid use does not affect transfusion in acetabular fracture surgery. Eur J Orthop Surg Traumatol. 2023 Oct 21. doi: 10.1007/s00590-023-03763-z.
  • 15. Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Banneyake EL, Gunasekera IS, Fang Y. A prophylactic TXA administration effectively reduces the risk of intraoperative bleeding during open management of pelvic and acetabular fractures. Sci Rep. 2023;13(1):12570. doi: 10.1038/s41598-023-39873-1.
There are 15 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Research Article
Authors

Necati Doğan 0000-0001-9503-5676

Publication Date December 31, 2023
Submission Date December 5, 2023
Acceptance Date December 26, 2023
Published in Issue Year 2023 Volume: 7 Issue: 3

Cite

Vancouver Doğan N. A New Effective And Reliable Technique For Bleeding Control İn The Modified Stoppa Approach To Acetabulum Quadrilateral Region Fractures; Ligate The Obturator Artery. Acta Med. Alanya. 2023;7(3):267-73.

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