The intrapelvic modified Stoppa approach is an important anterior exposure for acetabular trauma surgery. The intrapelvic modified Stoppa approach is an appealing, less invasive alternative to the ilioinguinal approach. The main advantage of the intrapelvic modified Stoppa approach is the avoidance of the middle window of the ilioinguinal approach, sparing dissection of the inguinal canal, the femoral nerve, and the external iliac vessels. The intrapelvic modified Stoppa approach affords superior and unremarkable access to the entire quadrilateral surface, the posterior column, and the pelvic brim as far posteriorly as the sacroiliac joint. The intrapelvic modified Stoppa approach can be used in combination with a small lateral iliac window to obtain access to the entire iliac fossa and facilitate reduction and fixation of associated iliac wing fracture extensions. T-shaped and transverse acetabular fractures with no associated posterior wall injury are typically approached based on the area of maximum displacement. Therefore, fractures in which the main area of displacement is at the posterior column should be approached via a posterior Kocher-Langenbeck approach. With the use of the intrapelvic modified Stoppa approach, which affords unremarkable access to the posterior column from the greater sciatic notch to the ischial spine, the anterior and posterior columns can be directly reduced and fixed, sparing the hip abductors, which may facilitate postoperative rehabilitation. In addition, the lateral and posterior soft tissues about the hip are left intact, which is an advantage if future total hip arthroplasty is required.

Our initial experience with the intrapelvic modified Stoppa approach in 34 consecutive patients (12 of whom had T-shaped or transverse acetabular fractures) was excellent, resulting in a low complication rate (one patient with an external iliac vein injury and four patients with an infection). Anatomic reduction was achieved in 69% of the patients. This video presents the intrapelvic modified Stoppa approach for the management of T-shaped acetabular fractures in which the main area of displacement is in the posterior column.