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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Surgery for acetabular fractures typically occurs 3 to 5 days after injury. Skeletal traction through the distal end of the ipsilateral femur is also routinely used. A more proximal extension indicated by dashed line may improve exposure in obese or muscular patients. Alternatively, oocher is achieved by enhancing skeletal traction on the femoral shaft with the extension table.
Kocher-Langenbeck Approach Make an incision that is 15 to 20 cm long and has 2 parts proximal and distalwhich are centered over the greater trochanter. Free the layer of fat covering the short external rotators, exposing the insertion of the piriformis tendon, the gemelli, and the internal obturator muscle. Open reduction and internal fixation of posterior wall fractures of the acetabulum.
Variations of the piriformis and sciatic nerve with clinical consequence: In the second most common variation, the nerve separates into 2 divisions above the piriformis; 1 branch passes through the piriformis fibers, and the other below the muscle.
After dissection through the distal part of the trochanteric bursa, the surgeon palpates the undersurface of the gluteus maximus muscle with his or her index finger and identifies the raphe, which separates the upper one-third from the lower two-thirds of the muscle which have a different kochdr supply: Two to twenty-year survivorship of the hip in patients with operatively treated acetabular fractures. Ann R Coll Surg Engl. Insert a retractor in the lesser sciatic notch and one anterosuperiorly in the direction of the anterior inferior spine.
Have the patient start physical therapy with isometric quadriceps and abductor strengthening exercises on the alproach postoperative day. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article http: Trochanteric mobilization may also require detachment of remaining gluteus medius and elevation of the vastus lateralis fascia from the vastus tubercle.
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.
Indications and contraindications for the Kocher-Langenbeck approach as well as preoperative imaging studies and planning. Video 4 Gluteus maximus dissection and identification of the sciatic nerve.
Delicate release and handling of the muscles attached to the greater trochanter are of paramount importance in order to protect the medial femoral circumflex artery.
The Kocher-Langenbeck Approach
We prefer the prone position for the Kocher-Langenbeck approach because it 1 allows for controlled traction of the limb, 2 facilitates easier positioning of the femoral head under the kovher acetabular dome, 3 makes the quadrilateral surface easier to palpate, and 4 makes the application of clamps through the greater sciatic notch easier. Video 8 Surgical anatomy demonstration.
At this stage, the dissection needed for most of the posterior fracture patterns is complete. Release the tendon of the piriformis muscle 1.
The hip capsule is separated from the conjoined tendon using a blunt instrument. This is facilitated by internal rotation of the femur.
The Kocher-Langenbeck Approach
Insert at least two suction drains. One of the complications of the Kocher-Langenbeck approach is the development of heterotopic ossification 13 The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 12. Introduction The Kocher-Langenbeck approach is langengeck approach to the posterior structures of the acetabulum. Chest rolls that allow for free abdominal movements are used. Tag the insertion of the tendon with a suture and release 1.
Understand the new fragment position after traction application Video 2 and maintain lsngenbeck only for the time period that is needed be mindful of traction neurapraxia. Close the subcutaneous tissue and the skin with number Vicryl suture and staples, respectively. Published online Jun The Kocher-Langenbeck approach is an approach to the posterior structures of the acetabulum. Posterior wall osteotomy of the acetabulum to access incarcerated marginal impaction.
Posterior Approach to the Acetabulum (Kocher-Langenbeck)
Detachment of the sacrospinous ligament and osteotomy of the ischial spine is very rarely performed and could provide wider access. In lantenbeck the surgical field, ensure that the gluteal cleft is covered and isolated and that the lateral and posterior aspects of the proximal part of the femur are easily accessible. J Orthop Surg Res.