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?.
|Published (Last):||5 January 2015|
|PDF File Size:||1.66 Mb|
|ePub File Size:||1.89 Mb|
|Price:||Free* [*Free Regsitration Required]|
Two to twenty-year survivorship of the hip in patients with operatively treated acetabular langenveck. Click here to view. Place a suture at least 1 cm lateral to its femoral insertion and dissect the tendon.
Safe release of gluteus maximus tendon in Kocher-Langenbeck approach for acetabular fracture reconstruction. The superior gluteal neurovascular bundle is exiting the greater sciatic notch superior to the level of the sciatic nerve and is identified with palpation of the superior gluteal artery. The quadratus femoris can be elevated from its origin to expose the distal extent of the posterior column as demonstrated in green. In this way, the inner aspect kochre the acetabulum is directly visible.
In transverse and T-type fractures, the femoral head tends to keep the acetabular fracture surfaces apart because of gravity, thus creating difficulties in reduction. If the posterior capsule is intact and direct inspection of the joint is required, a T-shaped capsulotomy is made. With the help of a Schanz screw placed in the femoral neck, distraction of the hip joint can be kangenbeck. We have observed that when the operative time is prolonged, the areas of the gluteus maximum muscle directly in contact with the Charnley retractor become devitalized and should be subsequently removed.
It allows direct visualization of the posterior column and the retroacetabular surface. Contact Disclaimer AO Foundation. 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.
Variations of the piriformis and sciatic nerve with clinical consequence: J Orthop Surg Res. Whenever possible, the labrum should not be detached from the acetabular rim. Identify and partially or fully release the langenbec maximus insertion at the femoral shaft.
Make sure that the piriformis and conjoined tendons are released from their trochanteric insertion without compromising the vascular supply koche the femoral head. Author information Copyright and License information Disclaimer. This is a safe approsch for sciatic nerve retractor placement. Now the posterior column is visible in its whole extent. 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.
The femoral head can be inspected after careful handling of the posterior wall, and intra-articular fragments and debris can be removed after gentle appgoach Video 7. Standard approaches to the acetabulum part 1: For acetabular fracture reduction, specialized reduction tools, such as pelvic reduction clamps and forceps, ball spike pushers, and bone hooks, are used.
The Kocher-Langenbeck Approach
Start the skin incision a few centimeters distal and lateral to the posterior superior iliac spine. Other implants that might be necessary, depending on the fracture type, are the one-third tubular plates used as spring plates and the 2.
Bring the C-arm image intensifier from the contralateral side and ensure that all of the necessary fluoroscopic views can be acquired. The palpable osseous landmarks of the Kocher-Langenbeck approach are the greater trochanter and the posterior superior iliac spine PSIS. Make sure that the appropriate operating table, instruments, and implants are available. Indications and contraindications for the Kocher-Langenbeck approach as well as preoperative imaging studies and planning. 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.
The disadvantages of the prone position are that 1 it does not allow for extension of the incision, i. Surgery for acetabular fractures typically occurs 3 to 5 days after injury.
Instruct the patient to take universal hip precautions if posterior wall reconstruction iocher been done. Less commonly, the nerve separates into 2 divisions above the piriformis; 1 branch passes above the muscle, the other passes below the muscle. Video 5 Piriformis identification and release.
The blue area indicates the additional exposure associated with trochanteric osteotomy. Protect the sciatic nerve, which lies behind the retractor, with abdominal sponges.
Posterior Approach to the Acetabulum (Kocher-Langenbeck) – Approaches – Orthobullets
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. Detachment of the sacrospinous ligament and osteotomy of the ischial spine is very rarely performed and could provide wider access. Meticulous hemostasis, application of drains, and watertight closure are the final steps of the operation. Surgical techniques—how do I do it?
Results The Langebneck approach is the workhorse for the surgical management of acetabular fractures and provides sufficient access to the majority of posterior based acetabular fractures Additional exposure to the cranial anterior portion of the acetabulum blue can be obtained with trochanteric osteotomy.
Posterior wall osteotomy of the acetabulum to access incarcerated marginal impaction. The Kocher-Langenbeck approach can be performed either in the prone as illustrated or lateral position. Have the patient return for clinical and radiographic follow-up at 2 and 6 weeks and then at 3, 6, 12, and 24 a;proach postoperatively. After the subcutaneous fat is incised, the iliotibial band is encountered.