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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Hip extension and knee flexion help to avoid undue tension to the sciatic nerve.
Acetabular fractures with marginal impaction: J Orthop Surg Res. Video 2 Patient positioning. Make sure that the appropriate operating table, instruments, and implants are available. Contraindications Anterior wall acetabular fractures.
A kochee proximal extension indicated by dashed line may improve exposure in obese or muscular patients. In the most common variation, an unsplit sciatic nerve passes distal to the unsplit fibers of the piriformis muscle. Ann R Coll Surg Engl.
End the incision at the mid third of the thigh just distal to the insertion of the gluteus maximus tendon. Quality of radiographic reduction and perioperative complications for transverse acetabular fractures treated by the Kocher-Langenbeck approach: Indications and contraindications for the Kocher-Langenbeck approach as well as preoperative imaging studies and planning. Ideally the exit point of the osteotomy will leave the piriformis origin partially attached to the trochanteric fragment.
Reattachment of the gluteus maximus tendon depends on the degree of the initial release. It should be noted that great anatomical variability of the area exists, especially in relation to the piriformis muscle and the sciatic nerve 89. Footnotes Published outcomes of this procedure can be found at: Detect if there is any marginal impaction or damage to the cartilage of the acetabulum and femoral head. Introduction The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 12.
This creates a posterior muscle belly inferior gluteal arteryand an anterior belly superior gluteal artery that includes one third of the gluteus maximus and the muscle of the tensor fascia latae. This will help to prevent accidental injury to the sciatic nerve when the fascia is incised distally.
Reinsert all tendons and approximate the split parts of the gluteus maximus with adaptation sutures. The dorsocranial articular acetabulum is also accessible either through the fracture gap or after a capsulotomy. The osteotomy is then carried out from the posterior trochanter anteriorly to mobilize the fragment.
The Kocher-Langenbeck Approach
Published online Jun The 2-level reconstruction of marginal impaction 10 – 12 takes place prior to posterior wall reconstruction. Standard approaches to the acetabulum part 1: Care must be taken to avoid injury to the medial circumflex femoral artery and thus should be avoided when possible.
They are tagged and incised 1 cm lateral from their femoral insertions to protect the medial circumflex femoral artery. After dissection through the distal part of the trochanteric bursa, the surgeon palpates the undersurface of the gluteus maximus muscle with his or her index finger and identifies the raphe, which separates the upper one-third from the lower two-thirds of the muscle which have a different vascular supply: The blue area indicates the additional exposure associated with trochanteric osteotomy.
Results The Kocher-Langenbeck approach is the workhorse for the surgical management of acetabular fractures and provides sufficient access to the majority of posterior based acetabular fractures Exercise care to avoid injury of the ascending branch of the medial circumflex femoral artery, which lies close to the tendinous insertions of the muscles.
Contact Disclaimer AO Foundation. Acta Chir Orthop Traumatol Cech. Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: Published outcomes of this procedure can be found at: Kocher-Langenbeck Approach Make an incision that is 15 to 20 cm long and has 2 parts proximal and distalwhich are centered over the greater trochanter.
Review the imaging studies anteroposterior pelvic and Judet oblique acetabular radiographic views and computed tomography [CT] images. 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 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.
Click here to view. 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.
The hip capsule is separated from the conjoined tendon using a blunt instrument. Variations of the sciatic nerve anatomy and blood supply in the gluteal region: Isolate the conjoined tendon of the obturator internus and superior and inferior gemelli muscles. Make sure that all of the osseous prominences are well padded. The disadvantages of the prone position are that 1 it does not allow for extension of the incision, i. Approach – more detail Back. The safest place to initially identify this structure is over the posterior surface of the quadratus femoris muscle.
Acetabulum – Approach – Kocher-Langenbeck approach – AO Surgery Reference
A safe technique of releasing the gluteus maximus tendon and protecting the first perforating branch of the profunda femoris artery is to perform a soft-tissue expansion by bluntly advancing a Cobb retractor between these structures, separating the muscle from the artery.
Insert a retractor in the lesser sciatic notch and one anterosuperiorly in the direction of the anterior inferior spine. April 26; 12 1: Induce anesthesia, administer intravenous antibiotics as per local hospital protocol, apply antiembolism stockings, langenbefk insert a Foley catheter to the bladder.
Identify the tendons of the piriformis and the gemelli muscles.
We prefer the lateral position in the following cases: Reflect the piriformis belly laterally to expose the retroacetabular surface to the greater sciatic notch.
This effect is probably more evident in patients with an infratectal or juxtatectal type of transverse fracture because of the fact that the reduction is not hindered by the weight of the leg, which occurs in the lateral position.