title: Modified Stoppa Approach versus Ilioinguinal Approach for Anterior Acetabular Fractures; A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Modified Stoppa approach was introduced as an alternative to ilioinguinal approach for management of anterior fractures of acetabulum in order to reduce complications of the latter. However, the efficacy of either approach over other is not well established. The aim of this meta-analysis is to compare the efficacy of modified stoppa and ilioinguinal approach in the management of acetabular fractures in terms of a) quality of reduction achieved b) complication rates c) functional outcomes d) operative time e) intra-operative blood loss.
  
  
  METHODS
  Databases of PubMed, EMBASE and Cochrane registry of controlled trials were taken into consideration for studies on modified Stoppa approach versus Ilioinguinal approach group for the treatment of anterior acetabular fractures. Dichotomous variables were presented as risk ratios (RRs) /Odds Ratio (OR) with 95% confidence intervals (CIs), and continuous data was measured as mean differences, with 95% CIs.
  
  
  RESULTS
  Four studies involving 375 patients were included in this meta-analysis. Out of those 375 patients, 192 were managed with ilioinguinal approach and 183 were managed with modified Stoppa approach. Anatomical reduction was significantly higher in Stoppa group (p=0.052, RR=1. 19 (1.02, 1.37),p=0. 90, I2=0%). The complication rate was significantly higher in the Ilioinguinal approach as compared with the Stoppa approach (p=0.01, RR 0.63 (0.44 to 0.91),p=0.73 (I2= 0%). The operative time was significantly shorter with modified Stoppa approach (MD = -48.79 (-80.29 to -17.30),p=0.002). No significant differences were found between the two groups in terms of their functional outcomes (p=0.63, RR 0.96 (-0.80 to 1.15),p=0. 56, I2=0%) and blood loss (MD= -212.89 (-476.27 to 50.49)p=0. 06, I2=71%).
  
  
  CONCLUSIONS
  Anterior acetabular fractures, if operated with the modified Stoppa approach were found to have better reduction and lower complication rates with less operative time, when compared to ilioinguinal approach. No significant difference in terms of blood loss was found in both the groups. Further higher quality randomized controlled trials are needed to verify our results.
authors.affiliation: Department of Orthopaedics, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Meena
authors.affiliation: Department of Orthopaedics, Pushpawati Singhania Research Institute, New Delhi 110017, India.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Sharma
authors.affiliation: Department of Orthopaedics, Woodend Hospital, Aberdeen, Scotland, U.K.
authors.forename: Samarth
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Department of Anaesthesiology, R. M. L. Hospital, New Delhi 110001, India.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Sharma
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
authors.forename: Buddhadev
authors.initials: B
authors.lastname: Chowdhury
keywords: Acetabular fractures; Functional outcomes; Ilioinguinal approach; Intraoperative blood loss; Modified stoppa approach; Quality of reduction