The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. J Orthop Trauma. Apr;25(4) doi: /BOT.0bef9ad6e. Modified Kocher-Langenbeck approach for the stabilization of posterior wall. Kocher-Langenbeck approach for acetabular # fixation– sath, Chennai, India. Arun Dr. Loading Unsubscribe from Arun Dr?.
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Posterior Approach to the Acetabulum (Kocher-Langenbeck) – Approaches – Orthobullets
It allows direct visualization of the posterior column and the retroacetabular surface. Reduce and stabilize the posterior wall using ball-spiked pushers and Kirschner wires. The outcome of the surgical management of acetabular fractures is multifactorial 16and it has been reported that the fracture type, sex, and age are prognostic factors for the outcome after open reduction and internal fixation using the Kocher-Langenbeck approach The palpable osseous landmarks of the Kocher-Langenbeck approach are the greater trochanter and the posterior superior iliac spine PSIS.
The Kocher-Langenbeck approach can be performed either in the prone as illustrated or lateral lsngenbeck.
Identify the sciatic nerve. Dissect very carefully at the supra-acetabular area to avoid injury to the gluteal neurovascular bundle. Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: To achieve access to the quadrilateral surface, carefully detach the obturator internus aapproach the inner table of the greater sciatic notch.
Release the tendon of the piriformis muscle 1. Have the patient return for clinical and radiographic follow-up at langenbbeck and 6 weeks and then at 3, 6, 12, and 24 months postoperatively.
It should be noted that great anatomical variability of the area exists, langenbrck in relation to the piriformis muscle and the sciatic nerve 89. In transverse and T-type fractures, the femoral head tends to lamgenbeck the acetabular fracture surfaces apart because of gravity, thus creating difficulties in reduction.
The reconstruction of posteriorly based fractures depends on the specific fracture type, and the goal is to provide stable column fixation and anatomical reconstruction of the acetabular articular surface, with column fixation performed before the reconstruction of the posterior wall.
Mobilizing the trochanteric fragment anteriorly now provides access to the cranial and anterior supraacetabular surface without excessive injury to the gluteus medius and minimus musculature. With the help of a Schanz screw placed in the femoral neck, distraction of the hip joint can be achieved. Note If no capsulotomy has been performed, the hip joint cannot be inspected after reduction fixation of the fragments.
If reattachment is performed, use an interrupted number Vicryl suture polyglactin; Ethicon.
Make an incision that is kcoher to 20 cm long and has 2 parts proximal and distalwhich are centered over the greater trochanter. Chest rolls that allow for free abdominal movements are used. One of the complications of the Kocher-Langenbeck approach is the development of heterotopic ossification 13 Surgical techniques—how do I do it?
Quality of radiographic reduction and perioperative complications for transverse acetabular fractures treated by the Kocher-Langenbeck approach: Carefully debride the edges of the fracture fragments before performing any reconstruction maneuvers. After the subcutaneous fat is incised, the iliotibial band is encountered. Additional exposure to the cranial anterior portion of the acetabulum blue can be obtained with trochanteric osteotomy.
The safest place to initially identify this structure is over the posterior surface of the quadratus femoris muscle. Meticulous hemostasis, application of drains, and watertight closure are the final steps of the operation.
The Kocher-Langenbeck Approach
Surgical approaches to the acetabulum and modifications in technique. J Orthop Surg Res. Reduce the posterior column using clamps, bone hooks, and joysticks, taking into account its 3-dimensional displacement.
The langsnbeck dissection at this stage is limited by the superior gluteal neurovascular structure, which needs to be protected. The hip aoproach is separated from the conjoined tendon using a blunt instrument. The Kocher-Langenbeck approach is an approach to the posterior structures of the acetabulum. Preparation and Patient Positioning Induce anesthesia, administer intravenous antibiotics as per local hospital protocol, apply antiembolism stockings, and insert a Foley catheter to the bladder.
Incise the iocher tract In the distal half, incise the iliotibial tract in line with its fibers up to the mid third of the thigh. Incise the joint capsule 0.
Posterior Approach to the Acetabulum (Kocher-Langenbeck)
Close the subcutaneous tissue and the skin with number Vicryl suture and staples, respectively. For acetabular fracture reduction, specialized reduction tools, such as pelvic reduction clamps approavh forceps, ball spike pushers, and bone hooks, are used.
Despite the fact that the Kocher-Langenbeck approach offers a wide access to the posterior elements of the acetabulum, the surgeon must remain cognizant that this approach is not extensile and whenever a wider exposure is needed, e.