Kocher-Langenbeck approach combined with partial proximal Watson-Jones incision for acetabular fractures involving weight-bearing area

Abstract

Objective To evaluate clinical outcomes of the Kocher-Langenbeck (K-L) approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area. Methods From January 2012 to January 2017, 20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome. They were 13 males and 7 females, with an average age of 40.7 years (range, from 22 to 67 years). According to the Letournel-Judet classification, there were 8 posterior wall fractures, one transverse fracture, one T-shaped fracture, one transverse and posterior wall fracture, 3 posterior column and posterior wall fractures, and 6 double-column fractures. All patients received open reduction and internal fixation with plates and screws. The outcomes of reduction were evaluated at follow-ups according to the Matta criteria. The hip function was evaluated according to the modified Merle d'Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups. Results All the 20 patients were followed up for an average of 8.2 months (range, from 7 to 21 months). They all obtained bony union after 10 to 18 weeks (average, 11.4 weeks). No fracture displacement, internal fixation loosening or deep infection occurred. According to the Matta criteria, anatomic reduction was achieved in 13 cases, satisfactory reduction in 6 cases, and unsatisfactory in one (a satisfactory rate of 95%). The modified Merle d'Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases, 7 good cases, 3 fair cases and one poor case (an excellent to good rate of 80%). Ectopic ossification of Brooker grade Ⅰ occurred in one case. The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17. Conclusions In the treatment of acetabular fractures involving the acetabular dome, the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area, enhance the anatomic matching of femoral head and acetabular roof, and reduce the difficulties in reduction and fixation. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Surgical approach