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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Acetabulum – Approach – Kocher-Langenbeck approach – AO Surgery Reference
Surgical approaches to the acetabulum and modifications in technique. The retroacetabular surface, the ischial spine, and the greater and lesser sciatic notches can be adequately visualized with the Kocher-Langenbeck approach. To achieve access to the quadrilateral surface, carefully detach the obturator internus from the inner table of the greater sciatic notch.
Be vigilant at all times to avoid injury to this structure, which can happen by direct laceration or undue traction of the abductors. Does postoperative radiation decrease heterotopic ossification after the Kocher-Langenbeck approach for acetabular fracture?
Despite the fact that the Kocher-Langenbeck approach offers a wide access to the posterior elements of the acetabulum, the surgeon must remain cognizant that this approach is not extensile and whenever a wider exposure is needed, e.
Detachment of the iocher ligament and osteotomy of the ischial spine is very rarely performed and could provide wider access. Whenever possible, the labrum should not be detached from the acetabular rim. A safe technique of releasing the gluteus maximus tendon and protecting the first perforating branch koche the profunda femoris artery is to perform a soft-tissue expansion by bluntly advancing a Lajgenbeck retractor between these structures, separating the langnebeck from the approafh.
The dissection then proceeds in this intervascular interval Video 3. Published online Jun It should be noted that great anatomical variability of the area exists, especially in relation to the piriformis muscle and the sciatic nerve 89. Take care not to compromise the gluteus maximus tendinous insertion.
Regardless of the prone or lateral position used for the approach, the sciatic nerve should be relaxed at all times. 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.
J Bone Joint Surg Am. Handle the sciatic nerve gently, avoiding excessive release of the surrounding fat tissue, and follow it up to the greater sciatic notch.
The Kocher-Langenbeck Approach
Reinsert all tendons and approximate the split parts of the gluteus maximus with adaptation sutures. Perform the closure of the iliotibial tract, the subcutis and the skin. Exposure This approach allows direct access to the area indicated in dark brown, limited cranially by the neurovascular bundle. Additional exposure to the cranial anterior portion of the acetabulum blue can be obtained with trochanteric osteotomy.
Incise the joint capsule 0. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of kkocher article http: Click here to view. Tag the insertion of the tendon with a suture and release 1.
Make sure that the horizontal limb of the incision is not too posterior. This is a safe area for sciatic nerve retractor placement. The disadvantages of the prone position are that 1 it does not allow for extension of the incision, i.
The Kocher-Langenbeck Approach
The sciatic nerve see illustration lies posterior to the gemelli and internal obturator muscles, and anterior to the piriformis muscle, between the greater trochanter and the ischial tuberosity.
This is particularly true for the conjoint tendon where passage of a needle into the tendon stump may injure the medial femoral circumflex artery. Video 5 Piriformis identification and release.
With the help of a Schanz screw placed in the femoral neck, distraction of the hip joint can be achieved. After the subcutaneous fat is incised, the iliotibial band is encountered. For fracture fixation, 3.
Visualization of the femoral head and acetabular surface is provided through the posterior wall fragment.
Always identify the lesser sciatic notch. Continue the incision anteriorly over the greater trochanter. Ann R Coll Surg Engl.