Proper evaluation and surgical planning is necessary to achieve anatomic reduction of the articular surface and stable fixation of the pelvic ring. According to the exclusion criteria, 22 patients who had undergone a single suprailioinguinal approach with a minimum of 1year followup were included in the study. On the following day after contouring the plates, a kocherlangenbeck approach was performed in our patient for proceeding with an open reduction of the fracture and a synthesis with interfragmentary screws and the pre contoured plates. Functional outcome of the surgical management of acute acetabular. Safe surgical technique for associated acetabular fractures. More complex injuries require combinations of the above or.
Data from all acetabular fractures n 96 treated surgically were collected between january 2012 and june 2015. Sep 11, 2019 kocher langenbeck approach pdf krividno pravo posebnideo, beograd, savremenemjerc i metode u prevenciji kriminaliteta,u. Surgical approaches to fractures of the acetabulum. May 10, 2020 so we combined the kocher langenbeck and iliofemoral approach until 1965, since when we have combined the ilioinguinal and kocher langenbeck approaches. The kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation.
This approach consists of an anterior and a posterior part. Associated acetabular fractures are challenging injuries to manage. The posterior part resembles kochers gibson, j bone joint surg 1950. The complexity of acetabulum fractures has always been challenging to the operating surgeon. Aug 11, 2016 anslateral approach the metanalysis by masonis and bourne found a dislocation rate for 14 studies involving 00 total hips 1. Only the modified stoppa approach was used in hips, while the kocherlangenbeck approach was additionally used in 9 hips table 3. Posterior wall acetabulum fracturedislocation with subsequent. Modified kocher langenbeck approach for the stabilization of posterior wall.
The kocher langenbeck approach is indicated for posterior wall, posterior column, transverse, transverse plus posterior wall, and some tshaped fractures figure 2. Single modified ilioinguinal approach for the treatment of a. Alternatively, you can download the file locally and open with any standalone pdf reader. File systems may use a storage device such as a hard disk or cdrom and involve maintaining the. On the following day after contouring the plates, a kocher langenbeck approach was performed in our patient for proceeding with an open reduction of the fracture and a synthesis with interfragmentary screws and the pre contoured plates. Kocherlangenbeck approach article in acta chirurgiae orthopaedicae et traumatologiae cechoslovaca 833. Modified kocherlangenbeck approach for the stabilization of posterior wall fractures of the acetabulum. Does postoperative radiation decrease heterotopic ossification after the kocherlangenbeck approach for acetabular fracture.
Modified stoppa approach for surgical treatment of acetabular. Fractures of the pelvis and acetabulum pdf free download. Radial head lateral approach approaches orthobullets. Modified ilioinguinal approach in combined surgical. A file system is a method for storing and organizing computer files and the data they contain to make it easy to find and access them. A conversion to open reduction via a kocherlangenbeck approach in the lateral position ensued. Users should refer to the original published version of the material krimlnalitet the full abstract. Historically, standard approaches for surgical treat ment of displaced acetabular fractures were the kocher. File processing systems was an early attempt to computerize the manual filing system that we are all familiar with. Kocher langenbeck approach was used for posterior wall and column fractures. Elementary fracture description associated fractures description posterior wall. It is a synovial ball and socket joint the capsule encloses the joint and is attached to the acetabular labrum medially laterally it is attached to the intertrochanteric line of the femur in front and along the posterior aspect of the neck of the bone behind anterosuperiorly capsule is thick and firmly attached and subjected to.
Modified iliofemoral approach with osteotomy of the iliac crest. In 2 cases one with the anterior column and posterior hemitransverse fracture and the other with bothcolumn fracture, a lateral window was made over the iliac crest simultaneously. Selecting surgical approaches for treatment of acetabular. The complex surgical approaches and the technical difficulty in achieving anatomical reduction imply that the learning curve to achieve highquality care of patients with such challenging injuries is extremely steep. Request pdf anterior approaches to the acetabulum posterior approaches to the hip joint were developed by langenbeck and kocher in the nineteenth century. The kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 1,2. Treatment of traumatic acetabulum lesions in an african. Pdf modified kocherlangenbeck approach in combined surgical. Morphological abnormalities of the hip in acetabular fractures. The impact of prone and lateral positioning on radiographic outcome and. Results of 167 consecutive cases of acetabular fractures using the. No further intraoperatively adjustments were needed for the plates. Langenbeck approach, the ilioinguinal approach and.
The kocherlangenbeck approach for the treatment of acetabular. The kocher langenbeck approach andreas panagopoulos, md, phd lecturer in orthopaedics university hospital of patras. It provides direct access to the outer surface of the posterior column and posterior wall and indirect access to the superior wall and quadrilateral surface. The kocher langenbeck approach involves a curvilinear or angular incision beginning just caudal of iliac crest and lateral to psis, extending over the tip of the greater trochanter below along the anterolateral border of the femur. An interactive surgical planning tool for acetabular. However, functionally significant heterotopic ossification with associated late bone defects in the posterior wall of the acetabulum is rare and challenging to treat. The anterior part is nearly identical with the ilioinguinal approach. Prophylaxis options include antiinflammatory oral medications, singledose radiation therapy, and debridement of gluteus minimus muscle. Treatment of intraarticular hip malignancy with extra. Modified ilioinguinal approach in combined surgical exposures for displaced acetabular fractures involving two columns springerplus, sep 2016 peng wang, xiaodong zhu, peng xu, yan zhang, lubo wang, xiangyan liu, weidong mu.
When heterotopic ossification is a late complication of failed acetabular fracture operation, it is disabling and may only be treated by tha. Ganz surgical hip dislocation via a posterior kocher langenbeck approach is a popular procedure in the management of femoroacetabular impingement fai. Theodor kocher 18411917 in 1911 described the caudal extension of langenbecksapproach the incision is an angular or curved one, extending from the base of the outer surface of the great trochanter upwards to its anterior superior angle, and from thence obliquely upwards and backwards in the direction of the gluteus maximus hyphenated. This is the most common variety of acetabular fracture. In a personal series of 225 operatively treated acetabular fractures, 128 were stabilized through a kocher langenbeck approach. Single modified ilioinguinal approach for the treatment of. Our retrospective study focused on the radiographic outcome and early complications of all trauma victims 1 suffering highenergy fractures, 2 who had been treated with orif 3 by a single surgeon, the senior author d. On the posterior side, the workhorse kocher langenbeck approach is shown by the leeds group and then compared with the use of surgical hip dislocation as illustrated by the bernese. Each approach has its specific, well defined field of indications. Specific complications of the kocher langenbeck approach are sciatic nerve palsy and periarticular ossifications.
The kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. Where the decision is made for open reduction the approach is determined by the column that is injured. Apr 26, 2017 our retrospective study focused on the radiographic outcome and early complications of all trauma victims 1 suffering highenergy fractures, 2 who had been treated with orif 3 by a single surgeon, the senior author d. Massive heterotopic ossification associated with late. They enable the internal fixation of the big majority of acute lesions. The incision is an angular or curved one, extending from the base of the outer surface of the great trochanter upwards to its anterior superior angle, and from.
Fractures of the pelvis and acetabulum are among the most challenging injuries to treat in orthopaedic surgery. Closed suction drainage is a routine part of wound management for patients undergoing surgical treatment of acetabulum fractures. Patients presenting with close displaced acetabular fractures of more than 2 mm within 10 days of injury. Dec 16, 20 on the day of admission day 0, an open reduction and internal fixation orif of the acetabular fracture was performed using a standard kocher langenbeck approach associated with a trochanteric flip. According to the chosen surgical approach, they were divided into 2 groups. A revision for suboptimal reduction was performed on day 10, followed by a second stage orif the next day using an ilioinguinal approach. Mar 26, 2019 on the anterior side, the traditional ilioinguinal approach is described by the leeds group and the newer stoppa and pararectus approaches, by the bernese group. We report the results of surgery performed through an anterolateral watsonjones approach in the management of anterolateral fai. The left hip was reduced and the acetabular fracture was treated with a kocher langenbeck approach in prone position. This first article in the journals safe surgical technique section presents the standard surgical care. Request pdf results of surgical treatment of acetabular fractures using kocherlangenbeck approach aim of the study.
Oct 23, 2015 controversy regarding heterotopic ossification ho prophylaxis exists after kocherlangenbeck for treatment of acetabular fracture. The pgroup included 43 patients, among them 32 male and 11 female patients with a median age of 55 range 1790 years. The femoral head and posterior wall were reduced under direct visualization with two 3. Results of surgical treatment of acetabular fractures. Posterior column injuries employ a posterior approach fig 16 for example, the kocher langenbeck.
Stable fixation of fractures was attained with reconstruction plates, while where. Introduction lanngenbeck kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 12. The kocherlangenbeck approach is indicated for posterior wall, posterior column, transverse, transverse plus. Prior literature has suggested singledose radiation therapy as the best prophylaxis to prevent ho formation. Dec 26, 20 heterotopic ossification is a common postoperative complication of acetabular fracture.
We describe a modified iliofemoral approach, with the particularity of including iliac. The treatment of femoral head fractures associated with acetabulum fractures, pipkin. Acetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture sites and the relatively low incidence of these lesions. Acetabular fractures, kocherlangenbeck, posterior approach, outcome.
Bmp9 expression in human traumatic heterotopic ossification. Kocher langenbeck approach, recon plates used for fixation. Apr 26, 2017 although the kocher langenbeck approach is considered as the golden standard for posterior access, studies dealing solely with this approach are rare 24,25,26,27, including a relatively small number of patients that ranges from 27 to 104. The kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. Stoppa approach 1, 2, posterior kocherlangenbeck approach and variants 3 or. Heterotopic ossification is most common with the extended iliofemoral approach and least common with the ilioinguinal approach.
File based approach 2 traditional file based systems o information are stored in data. Iatrogenic sciatic nerve injury is most common with the kocher langenbeck approach. The kocherlangenbeck approach was used for the osteosynthesis of acetabular fractures, while hue et al. Incision was carried out along the long axis of the femur distally and proximally along the anterior margin of the gluteus maximus. A kocher langenbeck, posterior approach was used, making sure to excise the previous biopsy tract. Eminently practical approach using more than 400 brilliant photographs, radiologic images, and drawings an emphasis on anatomical joint reconstruction to ensure the longest possible survival of the joint discussion on agespecific problems and complications, such as osteoporosis, thromboembolism, and more. To evaluate the results of acetabular fractures surgically treated using. The kocherlangenbeck approach is most frequently used for open. Posterior approach to the acetabulum kocher langenbeck ilioinguinal approach to the acetabulum extensile extended iliofemoral approach to acetabulum hip approaches hip anterior approach smithpetersen hip anterolateral approach watsonjones. The kocher langenbeck and the ilioinguinal approach are nonextensile approaches. No further intraoperatively adjustments were needed for.
If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. Pelvic injuries continue to have a high acute mortality and cause severe longterm disability. Results of 167 consecutive cases of acetabular fractures. Sep 03, 2019 decompression can be performed with a posterolateral approach to the hip including a kocher langenbeck or a gibson.
Three out of 100,000 inhabitants are estimated to suffer one each year 1. In anterior column injuries, iliofemoral or ilioinguinal approaches are used fig 15. Compartment syndrome of the lower extremity compartment. Surgical dislocation is performed through a kocherlangenbeck approach, utilising a. File based approach 1 traditional file based systems file based system predecessor to the dbms a collection of application programs that perform services for the endusers such as the production of reports. Due to the fact that the average age of the population is growing and that the elderly patients are maintaining an active. It is indicated for old fractures of the posterior wall and posterior column. Sagi, quality of radiographic reduction and perioperative complications for transverse acetabular fractures treated by the kocher langenbeck approach. Modified stoppa approach for surgical treatment of. Johnson workshop manual pdf make sure that all of the appropriate imaging studies radiographs and ct scans are displayed. Displaced fractures of the acetabulum are best treated with anatomical. Only the modified stoppa approach was used in hips, while the kocher langenbeck approach was additionally used in 9 hips table 3.