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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The femoral head can be inspected after careful handling of the posterior wall, and intra-articular fragments and debris can be removed after gentle traction Video 7.

Start the skin incision a few centimeters distal and lateral to the posterior superior iliac spine. Make sure that all of the osseous prominences are well padded. Perform the closure of the iliotibial tract, the subcutis and the skin. J Orthop Surg Res. Free the layer of fat covering the short external rotators, exposing the insertion of the piriformis tendon, the gemelli, and the internal obturator muscle.

Handle the sciatic nerve gently, avoiding excessive release of the surrounding fat tissue, and follow it up to the greater langebbeck notch.

Posterior Approach to the Acetabulum (Kocher-Langenbeck) – Approaches – Orthobullets

Detach the external rotator muscles Isolate the piriformis tendon. Video 5 Piriformis identification and release. Isolate the conjoined tendon of the obturator internus and superior and inferior gemelli muscles. This langehbeck facilitated by internal rotation of the femur. These screws can be inserted either independently or through the plate. J Am Acad Orthop Surg.

For fracture fixation, 3. Make sure that the appropriate operating table, instruments, and implants are available. Regardless of the prone or lateral position used for the approach, the sciatic nerve should be relaxed at all times. Tag the insertion of the tendon with a suture and release 1. J Bone Joint Surg Am.


The Kocher-Langenbeck Approach

After the subcutaneous fat is incised, the iliotibial band is encountered. 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.

Dissect very carefully at the supra-acetabular area to avoid injury to the gluteal neurovascular bundle. Less commonly, the nerve separates into 2 divisions above the piriformis; 1 branch passes above the muscle, the other passes below the muscle. Place a suture at least 1 cm lateral to its femoral insertion and dissect the tendon. The Kocher-Langenbeck approach can be performed either in the prone as illustrated or lateral position. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article http: The dorsocranial articular acetabulum is also accessible either through the fracture gap or after a capsulotomy.

The palpable osseous landmarks of the Kocher-Langenbeck approach are the greater trochanter and the posterior superior iliac spine PSIS. Introduction The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 12.

Identify and partially or fully release aapproach gluteus maximus insertion at the femoral shaft. Please review our privacy policy. Variations of the piriformis and sciatic nerve with clinical consequence: Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: Posterior wall osteotomy of the acetabulum to access incarcerated marginal impaction.

This is accomplished through the splitting of the muscle fibers of the gluteus maximus and the release of its tendinous femoral insertion along with the release of the piriformis and the short external rotators from their femoral insertion at the piriformis fossa. The distal part of the incision is in line with the longitudinal axis of the femur and starts 10 to 15 cm distal to the tip of the greater trochanter. Epub May Meticulous hemostasis, application of drains, and watertight closure are the final steps of the operation.


Insert at least two suction drains.

In the most common variation, an unsplit sciatic nerve passes distal to the aprpoach fibers of the piriformis muscle. Remove necrotic tissue and irrigate the entire wound to decrease the risk of periarticular ossification.

Posterior Approach to the Acetabulum (Kocher-Langenbeck)

Make sure that all of the appropriate imaging studies radiographs and CT scans are displayed. If reattachment is performed, use an interrupted number Vicryl suture polyglactin; Ethicon.

Open reduction and internal fixation of posterior wall fractures of the acetabulum. Overview Introduction The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach 12. Reflect the piriformis belly laterally to expose the retroacetabular surface to the greater sciatic notch. Standard approaches to the acetabulum part 1: Delicate release and handling of the muscles attached to the greater trochanter are of paramount importance appraoch order to protect the medial femoral circumflex artery.

Use one or two 3. It allows direct visualization of the approcah column and the retroacetabular surface. Introduction The Kocher-Langenbeck approach is an approach to the posterior structures of the acetabulum. Make sure that the piriformis and conjoined tendons are released from their trochanteric insertion without compromising the vascular supply of the femoral head.