Quality of Radiographic Reduction and Perioperative Complications for Transverse Acetabular Fractures Treated by the Kocher-Langenbeck Approach: Prone Versus Lateral Position

Abstract

To compare radiographic reduction, intraoperative factors, and perioperative complications for transversely oriented acetabular fractures treated by the Kocher-Langenbeck approach with the patient in either the prone or lateral position. Retrospective study. Two regional referral trauma centers. Sixty-six skeletally mature individuals with transversely oriented acetabular fractures treated operatively through the Kocher-Langenbeck approach in either the prone or lateral position. Operative fixation of an acute transverse acetabular fracture through the Kocher-Langenbeck approach. This study primarily assessed the radiographic reduction of two similar consecutive cohorts of patients surgically treated for transversely oriented acetabular fractures using the Kocher-Langenbeck approach with the patient positioned in either the lateral or prone position. Secondary outcome measures included operative time, estimated blood loss, and perioperative complications. Thirty-three transversely oriented acetabular fractures were reduced and stabilized with the patient in the lateral position, whereas 33 fractures were treated with the patient in the prone position. Demographic and injury variables as well as surgical time and estimated blood loss were similar between the two groups. Two postoperative infections occurred in each group, and one incomplete iatrogenic sciatic nerve palsy was recognized in the lateral group. The mean maximum fracture residual displacement measured on postoperative radiographs was 2.1 mm (range, 0-7 mm) in the lateral group compared with 1.3 mm (range, 0-7 mm) in the prone group (P = 0.08). The quality of reduction according to Matta's criteria was graded in prone positioned patients as anatomic in 20 patients (61%), imperfect in 11 patients (33%), and poor in two patients (6%), whereas lateral-positioned patients were graded as anatomic in 14 patients (42%), imperfect in 13 patients (40%), and poor in six (18%) patients (P = 0.21). This study demonstrated a trend toward higher radiographic residual fracture displacement in patients with transversely oriented acetabular fractures reduced and stabilized through the Kocher-Langenbeck approach in the lateral position compared with those positioned prone. However, no significant differences were observed in operative time, estimated blood loss, or perioperative complications between the two groups.