Introduction: The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach1,2. Step 2 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. Step 3 Kocher-Langenbeck Approach: Make an incision that is 15 to 20 cm long and has 2 parts proximal and distal , which are centered over the greater trochanter. Step 4 Fracture Reduction and Fixation: 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. Step 5 Wound Closure and Postoperative Care: Meticulous hemostasis, application of drains, and watertight closure are the final steps of the operation.
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Darstellung der dorsalen Seite des hinteren Azetabulumpfeilers. Indikationen Offene Reposition und innere Fixation der hinteren Azetabulumwand und des hinteren Pfeilers. Offene Reposition und innere Fixation von juxta- und infratektalen Querfrakturen. Offene Reposition und innere Fixation von Frakturen, die den vorderen und hinteren Pfeiler oder die Wand in Mitleidenschaft ziehen und bei denen der hintere Pfeiler oder die Wand direkt reponiert werden muss.
Kontraindikationen Frakturen der vorderen Azetabulumwand. Frakturen des vorderen Pfeilers. Frakturen beider Pfeiler, bei denen nur der vordere Pfeiler oder die vordere Wand direkt reponiert werden muss. Abstract Exposure of the posterior part of the posterior column of the acetabulum. Indications Open reduction and internal fixation of posterior wall and posterior column fractures. Open reduction and internal fixation of juxta- and infratectal transverse fractures.
Open reduction and internal fixation of fractures that involve both columns, when the posterior column or wall must be reduced under direct vision. Contraindications Fractures of the anterior wall. Fractures of the anterior column. Fractures which involve both columns, when the anterior wall or column has to be reduced under direct vision.
Surgical Technique Exposure of the posterior acetabular column through longitudinal splitting of the gluteus maximus muscle in its anterior third. Tenotomy of the piriform and of the obturator internus and gemelli muscles at their insertion in the piriform fossa. Reduction under direct vision of the fracture fragments of the posterior column or wall, indirect reduction of fractures running through the quadrilateral plate. Fixation of the fracture with lag screws posterior wall and a long curved plate that is placed parallel to the posterior acetabular rim.
Results In a 9-year period, 60 patients with a posterior wall fracture of the acetabulum were treated by open reduction and internal fixation through a Kocher-Langenbeck approach.
Seven patients Secondary neurologic problems were seen in five patients 8. Revision surgery was necessary in five patients 8. Of 46 patients examined clinically and radiologically after an average of 24 months, 32 This is a preview of subscription content, log in to check access.
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The Kocher-Langenbeck Approach: State of the Art.
Fractures of the acetabulum. Berlin, Germany: Springer-Verlag; Examples of available instruments for acetabular fracture reduction. Special instruments that permit intrapelvic and anterior column access A. Other useful reduction clamps, from left to right: large reduction forceps with points; pelvic reduction clamp; large pelvic reduction forceps with pointed ball tips; straight ball spike; Farabeuf reduction forceps; and serrated reduction forceps B. The status of the local soft tissues is an important additional consideration.
Acetabulum – Kocher Langenbeck Approach
Transverse acetabular fractures with the major displacement occurring at the anterior column. Associated both-column acetabular fractures. Anterior element reduction and fixation in T-type acetabular fractures. Anterior column and posterior hemitransverse acetabular fractures.
Der Kocher-Langenbeck-Zugang zur Behandlung von Azetabulumfrakturen
Acetabulum - Stoppa Approach Description The main surgical objective of the pelvic approaches is to access the pubic symphysis and superior pubic ramii. This is most often followed by open reduction and fixation of displaced superior pubic ramus fractures or to treat pubic symphysis disruption and diastasis. The main surgical objective of the acetabulum approaches is to access the acetabulum, most often followed by reconstruction in case of a fracture. It is important to know which approach to use, since each approach only gives access to a limited part of the acetabulum. The different approaches to the acetabulum include The ilioinguinal approach, which allows access to the anterior column and medial aspect of the acetabulum as well as access to the inner aspect of the pelvis from the sacroiliac joint to the symphysis pubis. The Kocher-Langenbeck approach, also known as the posterior approach, which allows access to the posterior wall of the acetabulum, the lateral aspect of the posterior column, the proximal femur as well as indirect access to the pelvis and anterior aspect of the posterior column.