{"title":"The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approach","authors":"Jade Naicker , Zithulele Nkosinathi Tshabalala , Andries Masenge , Obakeng Modisane , Steven Matshidza , Nkhensani Mogale","doi":"10.1016/j.tria.2024.100373","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The Modified Stoppa approach is a minimally invasive method of accessing the pelvis when treating pelvic ring and acetabular fractures. Although this approach is reported to be effective in exposing pelvic fractures, there are iatrogenic risks associated with the procedure. These risks arise from the inadvertent severing of vessels along the pelvic brim, resulting in bleeding, prolonged recovery, or even death. The specific vessels of concern include the corona mortis (CM) anastomosis and aberrant vasculature, which course over the superior pubic ramus.</div></div><div><h3>Methods</h3><div>The current study aimed to create and validate clinically significant safe zones to avoid injury to these anomalous vessels during the Modified Stoppa approach. Measurements were taken between the CM and crossing vessels (CV), as well as various bony landmarks encountered during the anterior approach, using 63 cadavers. Measurements were statistically analyzed for any significant differences between sides and sex using t-tests, and safe zones were formulated. The safe zones were then assessed for precision using a stepwise cadaver simulation of the Modified Stoppa approach.</div></div><div><h3>Results</h3><div>Safe zones from the pubic tubercle were calculated as 57.96 mm (SD ± 21.40) for the CM, while safe zones for the CV were reported as 48.07 mm (SD ± 25.52). These safe zones proved to be accurate when implemented during the cadaver simulation of the Modified Stoppa approach, as all cases of CM and aberrant vessels were positioned outside the prescribed zones.</div></div><div><h3>Conclusion</h3><div>The results reiterate the clinical significance of the CM and its impact on orthopedic surgery and patient care.</div></div>","PeriodicalId":37913,"journal":{"name":"Translational Research in Anatomy","volume":"38 ","pages":"Article 100373"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational Research in Anatomy","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2214854X24000979","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
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Abstract
Background
The Modified Stoppa approach is a minimally invasive method of accessing the pelvis when treating pelvic ring and acetabular fractures. Although this approach is reported to be effective in exposing pelvic fractures, there are iatrogenic risks associated with the procedure. These risks arise from the inadvertent severing of vessels along the pelvic brim, resulting in bleeding, prolonged recovery, or even death. The specific vessels of concern include the corona mortis (CM) anastomosis and aberrant vasculature, which course over the superior pubic ramus.
Methods
The current study aimed to create and validate clinically significant safe zones to avoid injury to these anomalous vessels during the Modified Stoppa approach. Measurements were taken between the CM and crossing vessels (CV), as well as various bony landmarks encountered during the anterior approach, using 63 cadavers. Measurements were statistically analyzed for any significant differences between sides and sex using t-tests, and safe zones were formulated. The safe zones were then assessed for precision using a stepwise cadaver simulation of the Modified Stoppa approach.
Results
Safe zones from the pubic tubercle were calculated as 57.96 mm (SD ± 21.40) for the CM, while safe zones for the CV were reported as 48.07 mm (SD ± 25.52). These safe zones proved to be accurate when implemented during the cadaver simulation of the Modified Stoppa approach, as all cases of CM and aberrant vessels were positioned outside the prescribed zones.
Conclusion
The results reiterate the clinical significance of the CM and its impact on orthopedic surgery and patient care.
期刊介绍：
Translational Research in Anatomy is an international peer-reviewed and open access journal that publishes high-quality original papers. Focusing on translational research, the journal aims to disseminate the knowledge that is gained in the basic science of anatomy and to apply it to the diagnosis and treatment of human pathology in order to improve individual patient well-being. Topics published in Translational Research in Anatomy include anatomy in all of its aspects, especially those that have application to other scientific disciplines including the health sciences: • gross anatomy • neuroanatomy • histology • immunohistochemistry • comparative anatomy • embryology • molecular biology • microscopic anatomy • forensics • imaging/radiology • medical education Priority will be given to studies that clearly articulate their relevance to the broader aspects of anatomy and how they can impact patient care.Strengthening the ties between morphological research and medicine will foster collaboration between anatomists and physicians. Therefore, Translational Research in Anatomy will serve as a platform for communication and understanding between the disciplines of anatomy and medicine and will aid in the dissemination of anatomical research. The journal accepts the following article types: 1. Review articles 2. Original research papers 3. New state-of-the-art methods of research in the field of anatomy including imaging, dissection methods, medical devices and quantitation 4. Education papers (teaching technologies/methods in medical education in anatomy) 5. Commentaries 6. Letters to the Editor 7. Selected conference papers 8. Case Reports
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