Journal of orthopaedic trauma
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Superomedial impaction of the anterior dome of the acetabulum is a known risk factor for poor outcomes after open reduction and internal fixation of acetabular fractures. The authors, using the anterior intrapelvic (modified Stoppa) approach to the acetabulum, describe a novel technique to help reduce and stabilize marginal impaction of the acetabular dome. In the senior author's experience, this technique has been helpful to achieve adequate reduction and stabilization.
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Authors previously have described anatomic structures commonly seen through the modified Stoppa approach; however, no study has formally quantified the areas and amount of visual bony exposure that is obtained. This information is important for proper preoperative planning of acetabulum fractures with regard to fracture reduction and fixation. The aim of this study was to quantify and describe the extent of bony pelvis exposed while identifying the limits of exposure from osseous landmarks within the dissection of the modified Stoppa approach. ⋯ The modified Stoppa approach allows for exposure of most (79%) of the inner true bony pelvis including the entire pelvic brim and 80% of the quadrilateral surface. On average, visualization is possible 2 cm above the pelvic brim and 5 cm below the pelvic brim along the quadrilateral surface, providing adequate anterior exposure for clamp and implant placement.
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Local delivery allows a high concentration of antibiotics to be achieved in the wound while avoiding the side effects and cost of systemic administration. Beads molded from polymethylmethacrylate cement are commonly used for local antibiotic delivery but are not ideal. The purpose of this study was to determine whether a bioabsorbable gel delivering vancomycin and gentamicin is more effective in reducing infection than beads delivering vancomycin and tobramycin. ⋯ These results suggest that antibiotic delivery by a gel is superior to beads. The authors propose that antibiotic depot by polymethylmethacrylate antibiotic beads is less effective because this method has to rely on diffusion of the antibiotic from the high concentration close to the beads to all regions of the wound.