The kocher langenbeck approach can be used for reduction and safe surgical dislocation with flip trochanteric osteotomy for fixation as a novel approach. The modified gibson surgical exposure of the acetabulum is a useful alternative to the kocher langenbeck approach. May 18, 2017 the study focused on the radiographic outcome and early complications of all trauma victims suffering highenergy fractures, who had been treated with orif by a single surgeon, the senior author d. Posterior approach to the acetabulum kocher langenbeck ilioinguinal approach to the acetabulum extensile extended iliofemoral approach to acetabulum. Lawerence d dorr, md and william t long md demonstrate a kocher langenbeck approach in the o. Modified kocher langenbeck approach for the stabilization of posterior wall. This was a retrospective cohort study at a regional level i trauma center. Review the patients general condition and imaging studies, plan the sequence of reduction and fixation, and make sure that all of the necessary equipment is available. In the above mentioned period of time, 65 acetabular fractures were diagnosed, 6 of which were surgically.
Antegrade femoral nailing in acetabular fractures requiring a. 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. Radial head lateral approach approaches orthobullets. A series of 42 consecutive cases treated during a 4 year period was analysed. The kocher langenbeck approach is a nonextensile approach to the posterior acetabular column. Exposure of the posterior part of the posterior column of the acetabulum. Stoppa approach to acetabulum approaches orthobullets. The kocher langenbeck approach was the work horse approach to the acetabulum for several decades 35 and acpht fractures may still be treated via a posterior approach by some surgeons. Therefore, the kocher langenbeck approach is still a working horse in approaching displaced acetabular fractures. Pdf modified kocherlangenbeck approach in combined surgical.
To assess whether modified kocherlangenbeck kl approach can. One patient died as a result of his injuries, and 2 were not. Treatment of transverse with or without posterior wall fractures of acetabulum using a modified smithpetersen combined with kocher langenbeck approach. The kocher langenbeck approach is indicated for posterior wall, posterior column, transverse. To evaluate the results of acetabular fractures surgically treated using posterior kocher langenbeck approach for internal fixation. The technique aims at achieving osteosynthesis by creating two windows. Kocher langenbeck is used to refer to an approach used to address the acetabulum which is more extensile southernmoore approach more commonly refers to a more limited hip arthroplasty approach incision is identical to kocher langenbeck, except localized posterior to greater trochanter.
Theodor kocher 18411917 in 1911 described the caudal extension of langenbeck sapproach 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 article describes a modification of kocher langenbeck approach for the treatment of select posterior wall fractures of acetabulum. The kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. 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. May 30, 2020 kocher langenbeck approach pdf posted on may 30, 2020 by admin the kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. The kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 1,2. We conducted a prospective, randomized study including 39 patients with acetabulum fractures.
It allows direct visualization of the acetabular articular surface, femoral head, posterior wall, posterior column, ischium, and greater and lesser sciatic notches figure indications orif of fractures of the posterior wall column. Tu hu c 1 haitao xu d 1 chaolai jiang b 2data interpretation geliang ren b 1 zhiquan an these authors contributed equally to this work corresponding author. Surgical approaches to fractures of the acetabulum. European journal of trauma and emergency surgery, 2010. Historically, standard approaches for surgical treat ment of displaced acetabular fractures were the kocher. The kocherlangenbeck approach andreas panagopoulos, md, phd lecturer in orthopaedics university hospital of patras. The approach spares the division of external rotators and of the. Surgical approaches to the acetabulum and modifications in t. Methods a series of 42 consecutive cases treated during a 4 year period was analysed. Results of surgical treatment of acetabular fractures using. The modified gibson posterior surgical approach to the. If fracture is displaced, open reduction of femoral head into acetabulum, reduction of femoral neck fracture, and stabilization of femoral neck fracture. Nov 26, 2019 the kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach.
May 10, 2020 kocher langenbeck approach pdf posted on may 10, 2020 the kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. The kocherlangenbeck approach is an approach to the posterior structures of the acetabulum. Posterior approach to the acetabulum kocherlangenbeck. Dec 10, 2020 the kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. Results of surgical treatment of acetabular fractures using kocher langenbeck approach. Modified kocherlangenbeck approach for the stabilization of posterior wall. Material and method over a period of four years 20082011, 42 patients were surgically treated by open reduction followed by internal fixation orif, using the posterior kocher langenbeck kl approach.
Aim of the study to evaluate the results of acetabular fractures surgically treated using posterior kocher langenbeck approach for internal fixation. Treatment of transverse with or without posterior wall. Current management of posterior wall fractures of the acetabulum. Modified kocherlangenbeck approach for the treatment of. Visualization and fixation of this fracture would be difficult with a standard.
Although antegrade femoral nailing is the best surgical tactic for many femur fractures, some authors caution against this approach when an ipsilateral kocher langenbeck approach for acetabular. Introduction the incidence of femoral head fracturedislocation is between 826% 1. The dorsocranial articular acetabulum is also accessible either through the fracture gap or after a capsulotomy. Closed suction drainage is a routine part of wound management for patients undergoing surgical treatment of acetabulum fractures. Although the kocher langenbeck approach 23 is considered as the golden standard for posterior access 3, studies dealing solely with this approach are rare 2427, including a relatively small number of patients that ranges from 27 to 104. Is there a benefit to drains with a kocherlangenbeck. This pilot study seeks to determine if there is a difference in wound healing for a kocher langenbeck approach with and without the use of drains.
During wound closure, patients were randomized into two groups. Surgical outcome of posterior column acetabular fractures. The role of patient positioning on the outcome of acetabular. Theodor kocher in 1911 described a curved incision starting from the posteriorinferior. Request pdf the kocherlangenbeck approach for the treatment of acetabular fractures objective. The kocher langenbeck approach is an approach to the posterior structures of the acetabulum. The kocher langenbeck approach consists of two parts. With the kl approach access to transverse or posterior column fractures extending cranially to the angle of the. It allows direct visualization of the posterior column and the retroacetabular surface. Differences in outcome of transverse acetabular fractures depending on the patients position. Pdf results of surgical treatment of acetabular fractures. Kocherlangenbeck approach for posterior wall acetabular. The kocherlangenbeck approach for the treatment of. Alexa o, malancea ri, puha b, lunca s, veliceasa b.
Kocher langenbeck approach pdf posted on may 10, 2020 the kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. The kocher langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. There is excellent exposure of the retroacetabular surface from the ischial tuberosity to the inferior portion of the iliac wing. Kocher langenbeck approach pdf posted on may 30, 2020 by admin the kocherlangenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach. Quality of radiographic reduction and perioperative complications for transverse acetabular fractures treated by the kocher langenbeck approach. Results of surgical treatment of acetabular fractures. We conducted a prospective, randomized study including 39 patients with acetabulum fractures treated through a kocher langenbeck approach. The advantages of the modified gibson posterior approach over the kocher langenbeck include increased anterosuperior direct access to the innominate bone and decreased risk of iatrogeni.
Kocher langenbeck approach with and without the use of drains. Comparison of the modified heuter approach and the kocher. Undoubtedly, surgeons expertise is a crucial factor 28. According to the letournel classification 9 posterior wall. The kocher langenbeck kl approach is the most commonly used surgical exposure for the stabilization of acetabular fractures involving a displaced posterior component 1, 2 and 3. Pelvic and acetabular surgical exposure kocher langenbeck approach prone. Compared with the kocher langenbeck approach, the modified heuter approach can effectively reduce the blood loss and operative time without increasing the risk of complications.
Kocher langenbeck approach the kocher langenbeck approach is primarily an approach to the posterior column of the acetabulum. If fracture is nondisplaced, stabilize fracture with parallel lag screws first. Results of 167 consecutive cases of acetabular fractures. Kochers depiction of the incision from his 1911 textbook. Differences in outcome of transverse acetabular fractures depending on the patients position european journal of trauma and emergency surgery, 2010.
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