A novel technique of plate positioning for fixation of posterior column acetabular fractures by modified Kocher-Langenbeck technique: A case series

Abstract

Introduction: Modified kocher-langenbeck technique aims at achieving osteosynthesis by creating two windows: between the gluteus medius and piriformis superiorly and between external rotators and ischial tuberosity inferiorly. The reconstruction plate can be slid under the piriformis and the short external rotators, we propose an easy way for the placement of the reconstruction plate Case report: We present a series of three cases with acetabular fractures posterior column fixed with reconstruction plates by modified kocher-langenbeck approach with a minimum follow up of 2 years. Case 1: 37yr male patient with right posterior column fracture left anterior and posterior column fracture, right posterior column and left anterior column are fixed with percutaneous screws, left posterior column fracture fixed with reconstruction plate and screws.Case 2: 45yr male patient with left posterior column fracture fixed with reconstruction plate and screws.Case 3: 41yr male patient with right posterior column fracture anterior column fracture fixed with reconstruction plate and screws. All the patients posterior column was fixed using modified kocher-langenbeck approach, all patients were followed for a period of 2 years, all patients had excellent outcome, there is no incidence of avascular necrosis of head in any case. Discussion: Modified kocher-langenbeck approach is tissue preserving and prevents damage to the vascularity of the head, in all the cases after reduction of fracture, an umbilical tape was tied to the end of the reconstruction plate using a long artery forceps the umbilical tape is pulled under the submuscular tunnel thus positioning the reconstruction plate under the intact short external rotators, the plate is fixed with appropriate screws. Use of this technique provides an easy positioning of reconstruction plate.