Acetabulum fracture an overview sciencedirect topics. Iilioinguinal incision was used in 6 patients, iliofemoral incision was used in 1 patient, and kocher langenbeck was used in 26 patients. Sciatic n kocher langenbeck, sciatic n iliofemoral, femoral n ilioingiunal periarticular ectopic bone formation greatest with lateral exposure of the innominate bone, highest with iliofemoral approach, followed by kocher langenbeck, and almost nonexistent with ilioingiunal or stoppa approaches. We prefer the prone position for the kocherlangenbeck approach because it 1. Pt positioned either prone or lateral using lag screws and a reconstruction plate placed from the ischium, over the retroacetabular surface onto the lateral ilium. Dec 29, 2019 human locomotion michaud pdf human locomotion has been turned into a series of video lectures, by dr. It allows direct visualization of the posterior column and the retroacetabular surface. Surgical approaches to the acetabulum suryanarayan p, kesavan.
Pdf modified kocherlangenbeck approach in combined. Aim of the study to evaluate the results of acetabular fractures surgically treated using posterior kocherlangenbeck approach for internal fixation. Oct 23, 2015 the kocher langenbeck approach was used in isolation in 63% 47 of 75 of patients treated with open reduction and internal fixation for acetabular fractures during this time period. The anterior column fractures were firstly reduced, temporarily fixed through a modified smithpetersen small incision, and finally fixed after the fixation of the posterior column and wall fractures, which were reduced and fixed through a kocherlangenbeck approach.
The kocherlangenbeck approach was used in isolation in 63% 47 of 75 of patients treated with open reduction and internal fixation for acetabular fractures during this time period. Treatment of transverse with or without posterior wall. Modified iliofemoral approach with osteotomy of the iliac. In a 9year period, 60 patients with a posterior wall fracture of the acetabulum were treated by open reduction and internal fixation through a kocherlangenbeck approach. The triradiate approach increases the incidence of ectopic bone. These two surgeons are linked through a common hyphenated eponym in orthopaedic surgery.
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 authors prefer to use the kocherlangenbeck approach with the patient in the prone position when it is being used for an isolated posterior wall fracture. Indomethacin 25mg potid or a localized singledose of xrt significantly decreases risk. Tom michaud, as well as clinical tools and rehab products for stateoftheart. Acute total hip arthroplasty for acetabular fractures in the. Modified kocher langenbeck approach for the stabilization of posterior wall. The surgical approach was determined according to the fracture type. In 2 6 % of patients, it occurs as a result of surgery and is more often associated with posterior fracture pattern treated through a kocherlangenbeck and extensile exposures. The kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 1,2. The surgeon uses his or her fingertips of the free hand to retract the sciatic nerve. Historically, standard approaches for surgical treat ment of displaced acetabular fractures were the kocher.
Outcome analysis of displaced acetabular fractures. Fractures are treated through a kocherlangenbeck approach. Standard posterior approach kocher langenbeck approach ideal indication. The kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. Specific complications sciatic nerve injury thirty percentage of acetabular fractures have associated sciatic nerve injury. Fractures of acetabulum free download as powerpoint presentation. Safe release of gluteus maximus tendon in kocherlangenbeck approach for acetabular fracture reconstruction. Kochers approach utilizes the interval between the anconeus and the extensor carpi ulnaris and can be extended proximally and distally. Emil theodor kocher was born on august 25, 1841, at bern. They developed a classification system and novel surgical approaches that still serve as the standard of care. Modified stoppa approach for surgical treatment of.
Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. The kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach1,2. Kocher received his medical doctorate in bern in 1865. Mansat and morrey described the use of a limited proximal lateral approach for capsular release for stiff elbows, which they termed the column procedure. Home annals archive volume 98, issue 03 safe release of gluteus maximus tendon in kocher langenbeck approach for acetabular fracture reconstruction. Aim of the study to evaluate the results of acetabular fractures surgically treated using posterior kocher langenbeck approach for internal fixation. Standard posterior approach kocherlangenbeck approach ideal indication. Modified kocherlangenbeck approach for the stabilization of. Open reduction and internal fixation of posterior wall and posterior column fract. According to the letournel classification 9 posterior wall fractures, 3 posterior column fractures, 11 transverse. Iilioinguinal incision was used in 6 patients, iliofemoral incision was used in 1 patient, and kocherlangenbeck was used in 26 patients. Read the use of a single limited posteriorapproach and reduction techniques for specific patterns of acetabular fractures, operative techniques in orthopaedics on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. Modified ilioinguinal approach in combined surgical. Modified kocherlangenbeck approach for the stabilization of posterior wall.
Langenbeck approach, the ilioinguinal approach and. The extended iliofemoral approach was used for associated anterior wall and anterior column fractures. Anterior wall column fractures transverse fractures both. When a posterior wall fracture is combined with posterior column injuries, this surgical approach is also generally effective. Radial head lateral approach approaches orthobullets. To assess whether modified kocherlangenbeck kl approach can substitute. Aug 14, 2017 some experts believed that ilioinguinal il and kocher langenbeck kl approaches were indispensable because neither the il nor kl approach alone was capable of exposing and managing all of the. Acute total hip arthroplasty for acetabular fractures in.
The kocherlangenbeck approach andreas panagopoulos, md, phd lecturer in orthopaedics. Free the layer of fat covering the short external rotators, exposing the. Pdf results of surgical treatment of acetabular fractures. Pdf modified kocherlangenbeck approach in combined surgical. Does postoperative radiation decrease heterotopic ossification. Modified stoppa approach for surgical treatment of acetabular. Outcome analysis of displaced acetabular fractures medcrave. This article presents the case of an elite rower with a large avulsion fracture involving the entire inferior obturator ring with a novel technique for open reduction using a limited kocherlangenbeck approach and percutaneous fixation using posterior column lag screws. Various windows of an ilioinguinal approach were combined with a kocherlangenbeck approach in 17% of 75 of patients.
In three hips 11 per cent, an initial kocherlangenbeck or ilioinguinal approach was inadequate to complete the reduction and fixation and a combined ilioinguinal and kocherlangenbeck approach was used, during the same session of anesthesia. Kocher langenbeck is used to refer to an approach used to address the acetabulum which is more extensile. The kocherlangenbeck approach is indicated for posterior wall, posterior column, transverse, transverse plus. 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. Southernmoore approach and the kocherlangenbeck approach both use the same interval. This article describes a modification of kocher langenbeck approach for the treatment of select posterior wall fractures of acetabulum. Fractures are treated through a kocher langenbeck approach. Human locomotion michaud pdf human locomotion has been turned into a series of video lectures, by dr. Posterior approach to the acetabulum kocherlangenbeck. This article describes a modification of kocherlangenbeck approach for the treatment of select posterior wall fractures of acetabulum. Various windows of an ilioinguinal approach were combined with a kocher langenbeck approach in 17% of 75 of patients.
You may not embed one of our images on your web page without a link back to our site. In difficult cases, particularly obese patients, cannulated screws may be beneficial. Surgical approaches to fractures of the acetabulum. The entry corridor for the screw applied through the kocher langenbeck approach is generally 12 cm anterior lateral to the apex of the sciatic notch. The kocherlangenbeck surgical approach the language spoken by orthopaedic surgeons is filled with eponyms. Fluoroscopy under anesthesia to check for hip joint stability and percutaneous screw xation are new upcoming management modalities. The modified ilioinguinal approach combined with kocherlangenbeck approach group group a included 46 patients. Acetabulum free download as powerpoint presentation. Pt positioned either prone or lateral using lag screws and a. Kocherlangenbeck is used to refer to an approach used to address the acetabulum which is more extensile. Choice of surgical approach the approaches to the acetabulum are classified as either limited basic or extensile depending on the degree of exposure accomplished and as anterior or posterior depending on the particular region they expose. Exposure of the posterior part of the posterior column of the acetabulum. Home annals archive volume 98, issue 03 safe release of gluteus maximus tendon in kocherlangenbeck approach for acetabular fracture reconstruction. The kocherlangenbeck approach for the treatment of.
In orthopaedics, perhaps more than any other medical. Safe release of gluteus maximus tendon in kocherlangenbeck. The standard ilioinguinal approach combined with kocherlangenbeck approach group group b included 27 patients. Treatment of specific fracture patterns posterior wall fractures. The free end of cable was then passed through the second hole of. According to the letournel classification 9 posterior wall fractures, 3 posterior column. The exposure is based on a dissection made anteriorly to the lateral border of. The anterior column fractures were firstly reduced, temporarily fixed through a modified smithpetersen small incision, and finally fixed after the fixation of the posterior column and wall fractures, which were reduced and fixed through a kocher langenbeck approach. Modified stoppa approach for surgical treatment of acetabular fracture ha yong kim, md, dae suk yang, md, chang kyu park, md, won sik choy, md department of orthopedic surgery, eulji university hospital, eulji university college of medicine, daejeon, korea received march 27, 2014.
Kocherlangenbeck approach is used for posterior wall, posterior column, and associated transverse patterns with central or posterior femoral head dislocation, whereas. Ppt acetabular fractures powerpoint presentation free. Feb 19, 20 specific complications sciatic nerve injury thirty percentage of acetabular fractures have associated sciatic nerve injury. Modified kocherlangenbeck approach for the stabilization. Posterior approach to the acetabulum kocher langenbeck. Free the layer of fat covering the short external rotators, exposing the insertion. If you would like a large, unwatermarked image for your web page or blog, please purchase the appropriate license. Pdf decision making in acetabulum fractures when to. Modified kocher langenbeck approach in combined surgical exposures for acetabular fractures management article pdf available in indian journal of orthopaedics 502. Southernmoore approach and the kocher langenbeck approach both use the same interval. Aug 25, 2014 in three hips 11 per cent, an initial kocher langenbeck or ilioinguinal approach was inadequate to complete the reduction and fixation and a combined ilioinguinal and kocher langenbeck approach was used, during the same session of anesthesia. In a 9year period, 60 patients with a posterior wall fracture of the acetabulum were treated by open reduction and internal fixation through a kocher langenbeck approach. If the fracture extends superiorly into the dome, a. Surgical approaches to the acetabulum suryanarayan p.
The kocherlangenbeck approach for the treatment of acetabular. Modified ilioinguinal approach in combined surgical exposures. Some experts believed that ilioinguinal il and kocherlangenbeck kl approaches were indispensable because neither the il nor kl approach alone was capable of exposing and managing all of the. Adequate positioning and free mobility of the limb. The dorsocranial articular acetabulum is also accessible either through the fracture gap or after a capsulotomy. The kocherlangenbeck approach is most frequently used for open reduction and internal fixation of transverse acetabular fractures, the positioning of the patient still falling to the preference of the surgeon. Useful alternative for kocher langenbeck posterior approach to acetabulum. Jun 27, 2018 the kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. May impact the surgical approach may require trochanteric osteotomy b. Acute total hip arthroplasty for acetabular fractures in the elderly 11 patients followed for 2 years elyazid mouhsine, raffaele garofalo, olivier borens, jeanfrangois fischer. The kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach.
The kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach1,2. Ppt acetabular fractures powerpoint presentation free to. Antegrade femoral nailing in acetabular fractures requiring a. Allow compression of free osteochondral fragments 2. The annals of the royal college of surgeons of england, 9803, pp. Avascular necrosis of the acetabulum sciencedirect. The kocher langenbeck approach is an approach to the posterior structures of the acetabulum. The technique aims at achieving osteosynthesis by creating two windows. Therefore, the kocherlangenbeck approach is still a working horse in. This article describes a modification of kocherlangenbeck approach for the. The operative time, intraoperative blood loss, quality of reduction matta criteria, perioperative complications, osseous union, subsequent complications, and hip function evaluation were recorded.
Chest rolls that allow for free abdominal movements are used. Review the patients general condition and imaging studies, plan the sequence of reduction and fixation. The kocherlangenbeck approach is indicated for posterior wall, posterior column, transverse, transverse plus posterior wall, and some tshaped fractures. Nov 26, 2019 the kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. Free video reveals how to remove tattoo naturaly from home. The impact of prone and lateral positioning on radiographic outcome and postoperative complication rates was evaluated by this retrospective study.
Kocher langenbeck approach for acetabular fractures michael githens. Southernmoore approach more commonly refers to a more limited hip arthroplasty approach. Outcome was assessed in operative time, blood loss, function outcomes and complications. Methods a series of 42 consecutive cases treated during a 4 year period was analysed. Les tableaux sont exclusivement disponibles en format pdf. Surgical treatment has been advocated for ischial tuberosity avulsion fractures in athletes. For more complex situations, in the 80s and 90s extended approaches extended iliofemoral approach according to letournel 12, its modification to reinert. Open reduction and percutaneous fixation of a rare.
858 1255 259 1631 149 1277 919 374 33 192 789 791 1368 1463 885 401 482 1543 1092 1234 1035 451 74 1597 409 1512 1373 93 861 692 312 384 600 1452 1436 801 820 727 585 186 508 1014 839 198 914 1162