Anterior intra-pelvic approach and corona mortis vascular anastomoses: A clinical anatomical study shows high frequency
Abstract
Background/Aim. Corona mortis vascular anastomoses (CMVA) must be located during surgical gold standard treatment method for displaced acetabular fractures. This study aimed to answer the following questions: What is the clinical frequency observed of CMVA? What is the composition of CMVA: arterial, venous or a combination? Methods. A retrospective review was made of 31 patients (24 males, 7 females; mean age 43.5 years) who underwent surgery for acetabular fractures between 2011 and 2015. The anterior intra-pelvic (AIP) approach was applied to all patients. By examination of the intraoperative CMVA compositions, the frequency of CMVA was determined together with identification of venous or arterial formation and distance from the pubic symphysis. Results. CMVA was observed during dissection in 29 (94%) patients and was ligated. In 14 (45%) patients, CMVA was recorded as venous, in 7 (23%) patients as arterial and in 8 (26%) patients as both. The mean distance of CMVA from the pubic symphysis was 35.9 mm (range 21.6–48.7 mm). Conclusion. The results showed very high CMVA frequency in the AIP approach, higher than previously reported in the English literature. Orthopedic surgeons should be aware about CMVA while doing this approach in surgical treatment of acetabular fractures.
References
Rommens P, Broos P, Vanderschot P. Preparation and technique for surgical treatment of 225 acetabulum fractures. 2 year re-sults of 175 cases. Unfallchirurg 1997; 100(5): 338–48. (German)
Tannast M, Najibi S, Matta JM. Two to twenty-year survivor-ship of the hip in 810 patients with operatively treated ace-tabular fractures. J Bone Joint Surg Am 2012; 94(17): 1559–67.
Cole JD, Bolhofner BR. Acetabular fracture fixation via a modi-fied Stoppa limited intrapelvic approach. Description of oper-ative technique and preliminary treatment results. Clin Or-thop Relat Res 1994; (305): 112–23.
Hammad AS, El-Khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the stand-ard ilio-inguinal versus the Stoppa/iliac approaches. Injury 2015; 46(2): 320–6.
Isaacson MJ, Taylor BC, French BG, Poka A. Treatment of ace-tabulum fractures through the modified Stoppa approach: strategies and outcomes. Clin Orthop Relat Res 2014; 472(11): 3345–52.
Hirvensalo E, Lindahl J, Kiljunen V. Modified and new ap-proaches for pelvic and acetabular surgery. Injury 2007; 38(4): 431–41.
Archdeacon MT, Kazemi N, Guy P, Sagi HC. The modified Stoppa approach for acetabular fracture. J Am Acad Orthop Surg 2011; 19(3): 170–5.
Bastian JD, Tannast M, Siebenrock KA, Keel MJ. Mid-term re-sults in relation to age and analysis of predictive factors after fixation of acetabular fractures using the modified Stoppa ap-proach. Injury 2013; 44(12): 1793–8.
Elmadağ M, Güzel Y, Acar MA, Uzer G, Arazi M. The Stoppa approach versus the ilioinguinal approach for anterior ace-tabular fractures: a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res 2014; 100(6): 675–80.
Kacra BK, Arazi M, Çiçekcibaşı AE, Büyükmumcu M, Demirci S. Modified medial Stoppa approach for acetabular fractures: an anatomic study. J Trauma 2011; 71(5): 1340–4.
Sagi HC, Afsari A, Dziadosz D. The anterior intra-pelvic (modified rives-stoppa) approach for fixation of acetabular fractures. J Orthop Trauma 2010; 24(5): 263–70.
Berberoğlu M, Uz A, Özmen MM, Bozkurt MC, Erkuran C, Taner S, et al. Corona mortis. Surg Endosc 2001; 15(1): 72–5.
Darmanis S, Lewis A, Mansoor A, Bircher M. Corona mortis: an anatomical study with clinical implications in approaches to the pelvis and acetabulum. Clin Anat 2007; 20(4): 433–9.
Gobrecht U, Kuhn A, Fellman B. Injury of the corona mortis during vaginal tape insertion (TVT-Secur™ using the U-Approach). Int Urogynecol J 2011; 22(4): 443–5.
Ramser M, Messmer AS, Zbinden I, Von Holzen U, Nebiker CA. Incarcerated obturator hernia–laparoscopic repair with in-traoperative view of the corona mortis. J Surg Case Rep 2014; 2014(8): pii: rju081.
Rusu MC, Cergan R, Motoc AG, Folescu R, Pop E. Anatomical considerations on the corona mortis. Surg Radiol Anat 2010; 32(1): 17–24.
Sarikcioglu L, Sindel M, Akyildiz F, Gur S. Anastomotic vessels in the retropubic region: corona mortis. Folia Morphol (Warsz) 2003; 62(3): 179–82.
Judet R, Judet J, Lanzetta A, Letournel E. Fractures of the ace-tabulum. Classification and guiding rules for open reduction. Arch Ortop 1968; 81(3): 119–58. (Italian)
Hirvensalo E, Lindahl J, Böstman O. A new approach to the in-ternal fixation of unstable pelvic fractures. Clin Orthop Relat Res 1993; (297): 28–32.
Tornetta P 3rd, Hochwald N, Levine R. Corona mortis. Incidence and location. Clin Orthop Relat Res 1996; (329): 97–101.
Lau H, Lee F. A prospective endoscopic study of retropubic vascular anatomy in 121 patients undergoing endoscopic ex-traperitoneal inguinal hernioplasty. Surg Endosc 2003; 17(9): 1376–9.
Okcu G, Erkan S, Yercan HS, Ozic U. The incidence and loca-tion of corona mortis: a study on 75 cadavers. Acta Orthop Scand 2004; 75(1): 53–5.
Stavropoulou-Deli A, Anagnostopoulou S. Corona mortis: anatomi-cal data and clinical considerations. Aust N Z J Obstet Gynae-col 2013; 53(3): 283–6.
Karakurt L, Karaca I, Yılmaz E, Burma O, Serin E. Corona mor-tis: incidence and location. Arch Orthop Trauma Surg 2002; 122(3): 163–4.
Sakthivelavan S, Aristotle S, Sendiladibban SD, Jebakkani CF. Variability of the obturator artery and its surgical implications in a South Indian population. Eur J Anat 2013; 17(3): 159–65.
Pai MM, Krishnamurthy A, Prabhu LV, Pai MV, Kumar SA, Hadimani GA. Variability in the origin of the obturator artery. Clinics (Sao Paulo) 2009; 64(9): 897–901.
Teague DC, Graney DO, Routt ML Jr. Retropubic vascular haz-ards of the ilioinguinal exposure: a cadaveric and clinical study. J Orthop Trauma 1996; 10(3): 156–9.
Hong HX, Pan ZJ, Chen X, Huang ZJ. An anatomical study of corona mortis and its clinical significance. Chin J Traumatol 2004; 7(3): 165–9.
Pungpapong S, Thum-umnauysuk S. Incidence of corona mortis; preperitoneal anatomy for laparoscopic hernia repair. J Med Assoc Thai 2005; 88(Suppl 4): S51–3.