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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Detect if there is any marginal impaction or damage to langnebeck cartilage of the acetabulum and femoral head. Safe release of gluteus maximus tendon in Kocher-Langenbeck approach for acetabular fracture reconstruction.
Additional exposure to the cranial anterior portion of the acetabulum blue can be obtained with trochanteric osteotomy. Identify the sciatic nerve.
Video 6 Obturator internus and gemelli identification and release. Reduce and stabilize the posterior wall using ball-spiked pushers and Kirschner wires. We prefer the lateral position in the following cases: Published online Jun Contraindications Anterior wall acetabular fractures. Exercise care to avoid injury of the ascending branch of the medial circumflex femoral artery, which lies close approaach the kocherr insertions of the muscles.
Posterior Approach to the Acetabulum (Kocher-Langenbeck) – Approaches – Orthobullets
Paproach 26; 12 1: Now the posterior column is visible in its whole extent. The authors indicated that no external funding was received for any aspect of this work. J Orthop Surg Res.
Surgical techniques—how do I do it? Variations kochre the sciatic nerve anatomy and blood supply in the gluteal region: Video 8 Surgical anatomy demonstration.
Reflect the piriformis belly laterally to expose the retroacetabular surface to the greater sciatic notch. Note The repair of these tendons at the time of closure represents additional risk to the femoral head circulation. The femoral head can be inspected after careful handling of the posterior wall, and intra-articular fragments and debris can be removed after gentle traction Video 7.
Exposure This approach allows direct access to the area indicated in dark brown, limited cranially by the neurovascular bundle.
Posterior Approach to the Acetabulum (Kocher-Langenbeck)
The quadratus femoris can be elevated from its origin to expose the distal extent of the posterior column as demonstrated in green. Detach the external rotator muscles Isolate the piriformis tendon. Open reduction and internal fixation of posterior wall fractures of the acetabulum. Quality of radiographic reduction and perioperative complications langebeck transverse acetabular fractures treated by the Kocher-Langenbeck approach: Use one or two 3.
Reinsert all tendons and approximate the split parts of the gluteus maximus with adaptation sutures. Instruct the patient to take universal hip precautions if posterior wall reconstruction has been done. Two to twenty-year survivorship of the hip in patients with operatively treated acetabular fractures.
Detachment of the sacrospinous ligament and osteotomy of the ischial spine is very rarely performed and could provide wider access. The retroacetabular surface, the ischial spine, and the greater and lesser sciatic notches can lagnenbeck adequately visualized with the Kocher-Langenbeck approach.
If the posterior capsule is intact and direct inspection of the joint is required, a T-shaped capsulotomy is made.
Acetabulum – Approach – Kocher-Langenbeck approach – AO Surgery Reference
J Bone Joint Surg Am. Marginal impaction in posterior wall fractures of the acetabulum. This is accomplished through the splitting of the muscle fibers of the gluteus maximus and the release of its tendinous femoral insertion along with the release of the piriformis and the short external rotators from their femoral insertion at the piriformis fossa.
Video kocherr Piriformis identification and release. Overview Introduction The Kocher-Langenbeck approach iocher the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 12.
The Kocher-Langenbeck Approach
The tendon is tagged and released 1. This effect is probably more evident in patients with an infratectal or juxtatectal type of transverse fracture because of the fact that the approacu is not hindered by the weight of the leg, which occurs in the lateral position.
End the incision at the mid third of the thigh just distal to the insertion of the gluteus maximus tendon. Wound Closure and Postoperative Care Meticulous hemostasis, application of drains, and watertight closure are the final steps of the operation. If reattachment is performed, use an interrupted number Vicryl suture polyglactin; Ethicon.
Split the gluteus maximus Split the gluteus maximus in line with its fibers, starting at the greater trochanter in a proximal direction up to the crossing of the first neurovascular bundle. Remove necrotic tissue and irrigate the entire wound to decrease the risk of periarticular ossification.
In patients with extension of the fracture fragments proximally, identify the superior gluteal artery as previously described and place the plate under it. Carefully debride the edges of the fracture fragments before performing any reconstruction maneuvers. Induce anesthesia, administer intravenous antibiotics as per local hospital protocol, apply antiembolism stockings, and insert a Foley catheter to the bladder.