Abstract
The Kocher-Langenbeck (K-L) approach is the ‘workhorse’ of surgery for acetabular fractures needing posterior fixation. It is indicated for most of these fractures for proper surgical technique and optimal outcome. We therefore evaluated the outcome of surgically treated acetabular fractures through the K-L approach in our setting with limited resources. 57 patients were operated by the K-L approach during the 3-year study period. The most common indications of this approach were: posterior wall (38.6%) and transverse + posterior wall fractures (36.8%). Based on Matta’s criteria of fracture reduction, 81 % were judged anatomic, 16% imperfect and 3 % poor. A surgery waiting time of 8 to 14 days after injury, significantly favoured anatomic fracture reduction. The MAP score was excellent in 72 % and unacceptable in 10.6 %. Factors associated with poor outcomes were poor fracture reduction and the development of early post-operative complications. Iatrogenic sciatic nerve palsy (ISNP) was the most significant post-operative complication (19.3%). The levering of Hohmann retractors in the sciatic notches was the major risk factor for developing ISNP, compared to the use of sciatic nerve retractors. Other early and late complications included surgical site infections (12.3%) and heterotopic ossification (8.8 %), respectively. The overall outcome following surgery by the K-L approach is satisfactory. However, there is need to ameliorate the technique, especially at the level of instrumentation, to limit post-operative complications.
Highlights
INTRODUCTIONIncluded in our study, were work by Judet and Letournel, there has been lim- all patients who were operated for closed aceited clarity regarding the management of acetab- tabular fractures through the K-L approach, who ular fractures [1,2]
Over the past 60 years, following pioneering trauma interventions
Fracture reduction on post-operative conpopulation, with only some early results reported trol radiographs was assessed by 2 independent by Letournel [3]. We carried out this orthopaedic surgeons, not involved in the patient study to assess the outcomes of acetabular frac- management
Summary
Included in our study, were work by Judet and Letournel, there has been lim- all patients who were operated for closed aceited clarity regarding the management of acetab- tabular fractures through the K-L approach, who ular fractures [1,2] Since their early works [2,3,4], consented to take part. Proper surgical technique for ace- After the approach and protection of the sciatic tabular surgery must begin with a better under- nerve, the fracture patterns were identified Fracstanding of this widely used approach, indicated tures were reduced with pointed reduction in the majority of acetabular fractures requiring clamps and temporarily fixed with K-wires.
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