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Published on: September 7, 2022
[Posterior approaches to the acetabulum]
K-A Siebenrock1, M Tannast, J D Bastian
1Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Universitätsspital Bern, Inselspital, Freiburgstraße 3, CH-3010 Bern, Schweiz. klaus.siebenrock@insel.ch
Insights
Surgical hip dislocation, an extension of the Kocher-Langenbeck approach, improves visualization for complex acetabular fractures. This technique aids in evaluating and managing joint damage, enhancing outcomes in elderly patients with challenging fractures.
Area of Science:
- Orthopedic surgery
- Trauma surgery
Context:
- Posterior hip approaches, including the Kocher-Langenbeck, have evolved since the 19th century.
- Surgical hip dislocation offers enhanced visualization of the entire joint.
Purpose:
- To evaluate the utility of surgical hip dislocation in managing complex acetabular fractures, particularly in the elderly.
- To assess the benefits of direct joint visualization for identifying and correcting complicating factors.
Summary:
- Surgical hip dislocation, an extension of the Kocher-Langenbeck approach, provides complete visualization of the hip joint.
- This technique is advantageous for complex acetabular fractures with multifragmentary posterior wall involvement, dome/marginal impaction, and femoral head damage.
- Direct visualization allows for reliable recognition and correction of negative prognostic factors, improving surgical outcomes.
Impact:
- Surgical hip dislocation is a valuable approach for complex acetabular fractures, especially in elderly patients with complicating factors.
- Improved visualization and management of intra-articular damage can lead to better functional outcomes.
- This technique represents a standard of care for specific complex acetabular fracture patterns.
Abstract:
Posterior approaches to the hip joint were developed by Langenbeck and Kocher in the nineteenth century. Letournel created the term Kocher-Langenbeck approach which became one of the most important approaches to the hip joint. The further extension of this approach by digastric trochanteric osteotomy and subsequently by surgical hip dislocation enables visualization of the entire hip joint which allows complete evaluation of articular joint damage, quality of reduction and confirmation of extra-articular hardware. With the increasing incidence of acetabular fractures in the elderly there is a concomitant increase of complicating factors, such as multifragmentary posterior wall fractures, dome impaction, marginal impaction and femoral head damage. These factors are negative predictors and compromise a favorable outcome after acetabular surgery. With direct joint visualization these factors can be reliably recognized and corrected as adequately as possible. Surgical hip dislocation thus offers advantages in complex posterior wall, transverse and T-shaped fractures with or without posterior wall involvement. For these fracture types surgical hip dislocation represents a standard approach in our hands.
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