The Kocher-Langenbeck Approach for the Treatment of Acetabular Fractures

Abstract

Objective:

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 infra-tectal 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. 27 patients (45%) had additional lesions of the acetabular cavity. Seven patients (11.6%) had a primary nerve palsy. Secondary neurologic problems were seen in five patients (8.3%). Revision surgery was necessary in five patients (8.3%). Of 46 patients examined clinically and radiologically after an average of 24 months, 32 (69.6%) obtained an excellent or good result using the Merle d’Aubigné & Postel score. 34 patients (73.9%) did not develop periarticular ossifications.