The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approach
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 a...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
|
| Series: | Translational Research in Anatomy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214854X24000979 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832589969101684736 |
|---|---|
| author | Jade Naicker Zithulele Nkosinathi Tshabalala Andries Masenge Obakeng Modisane Steven Matshidza Nkhensani Mogale |
| author_facet | Jade Naicker Zithulele Nkosinathi Tshabalala Andries Masenge Obakeng Modisane Steven Matshidza Nkhensani Mogale |
| author_sort | Jade Naicker |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-386873b52c924740a78f2f2aae749f68 |
| institution | Kabale University |
| issn | 2214-854X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Translational Research in Anatomy |
| spelling | doaj-art-386873b52c924740a78f2f2aae749f682025-01-24T04:45:14ZengElsevierTranslational Research in Anatomy2214-854X2025-03-0138100373The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approachJade Naicker0Zithulele Nkosinathi Tshabalala1Andries Masenge2Obakeng Modisane3Steven Matshidza4Nkhensani Mogale5Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Gauteng, 9 Bophela Road, South Africa; Corresponding author. Dr Savage Road, Prinshof 349-Jr, Pretoria, 0084, Basic Medical Sciences building, Room 3-17, Prinshof Medical Campus, University of Pretoria, South Africa.Department of Human Biology and Integrated Pathology, Medical School, Faculty of Health Sciences, Nelson Mandela University, Eastern Cape, Old Uitenhage Road, South AfricaDepartment of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Gauteng, Lynwood Road and Roper Street, South AfricaDepartment of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Gauteng, 9 Bophela Road, South AfricaDepartment of Orthopaedics, Faculty of Health Sciences, School of Medicine, University of Free State, Free State, 3 Budget Avenue, South AfricaDepartment of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Gauteng, 9 Bophela Road, South AfricaBackground: 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.http://www.sciencedirect.com/science/article/pii/S2214854X24000979AnastomosisOrthopedic surgeryPelvisFractureSimulation |
| spellingShingle | Jade Naicker Zithulele Nkosinathi Tshabalala Andries Masenge Obakeng Modisane Steven Matshidza Nkhensani Mogale The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approach Translational Research in Anatomy Anastomosis Orthopedic surgery Pelvis Fracture Simulation |
| title | The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approach |
| title_full | The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approach |
| title_fullStr | The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approach |
| title_full_unstemmed | The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approach |
| title_short | The evaluation of safe zones for the corona mortis using a cadaver simulation of the Modified Stoppa approach |
| title_sort | evaluation of safe zones for the corona mortis using a cadaver simulation of the modified stoppa approach |
| topic | Anastomosis Orthopedic surgery Pelvis Fracture Simulation |
| url | http://www.sciencedirect.com/science/article/pii/S2214854X24000979 |
| work_keys_str_mv | AT jadenaicker theevaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT zithulelenkosinathitshabalala theevaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT andriesmasenge theevaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT obakengmodisane theevaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT stevenmatshidza theevaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT nkhensanimogale theevaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT jadenaicker evaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT zithulelenkosinathitshabalala evaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT andriesmasenge evaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT obakengmodisane evaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT stevenmatshidza evaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach AT nkhensanimogale evaluationofsafezonesforthecoronamortisusingacadaversimulationofthemodifiedstoppaapproach |