Kocher-Langenbeck Approach Research Articles

Prone or lateral patient positioning in KocherLangenbeck approach in acetabular fractures fixation: A systematic review and meta-analysis

The Kocher-Langenbeck (K-L) approach is the approach of choice to treat fractures involving the posterior acetabulum. It provides direct exposure to the acetabulum, adequate reduction, and access to treat associated hip fractures. However, there is no consensus on the positioning of the patient; prone or lateral. This review aimed to investigate the effect of patient positioning on the outcomes of the K-L approach in acetabular fracture fixation. Cochrane, Web of Science, Google Scholar, and PubMed were searched from inception until February 22, 2022. Inclusion criteria encompassed studies that investigated acetabular fracture fixation utilizing the K-L approach in relation to patient positioning (Prone and/or Lateral). Only English manuscripts that reported at least one of the outcomes of interest were included in the study. Studies that utilized both positions without specifying the outcomes in relation to the patient position were excluded from the study. The Newcastle–Ottawa Scale and the Joanna Briggs Institute tool were utilized to assess the quality of the included studies. This study included 521 patients from six articles. Of those patients, 46.1% were operated on in the lateral position and 53.9% in the prone position. The mean operative time of lateral and prone positions was 160.9 min (95% confidence intervals [CI]: 135.11–186.64) and 212.5 min (95% CI: 167.08–257.94), respectively. The mean blood loss in the lateral position was 502.mL (95% CI: 471.61–532.47) compared to 482.5 mL (95% CI: 396.77–568.28) in the prone position. The pooled complications in the lateral position were 29% (95% CI: 19–39%) compared to 37% (95% CI: 6–75%) in the prone position. The outcomes did not significantly differ when comparing lateral and prone patient positioning for posterior acetabular fracture fixation through the K-L approach. Further prospective randomized controlled studies are recommended to reach the best evidence.

The anterior transmuscular intrapelvic approach for the treatment of acetabular fractures—a new anterior surgical strategy

The anterior ilioinguinal and the posterior Kocher-Langenbeck approach have long been the standard surgical approaches to the acetabulum. The last decade has witnessed the development of so-called intrapelvic approaches for anterior pathologies because they provide better exposure of the quadrilateral plate. Currently, the modified Stoppa approach and the pararectus approach are frequently used by surgeons for the treatment of acetabular fractures. We investigated an even more direct access to the entire anterior column and the quadrilateral plate via the abdominal wall muscles, between the incisions for the ilioinguinal and the pararectus approach.After intensive study of anatomic specimens, a cadaver dissection was performed prior to clinical application. The approach was then used in 20 patients who were assessed retrospectively.Postoperative CT scans showed that, according to the Matta scoring system, the quality of fracture reduction was “anatomical” (≤ 1 mm) in 12 (60%), “imperfect” (2–3 mm) in four (20%), and “poor” (> 3 mm) in four (20%) patients. Numerous minor complications were observed; the majority of these had resolved at the time of discharge.In conclusion, the anterior transmuscular intrapelvic approach (ATI) is a safe and effective alternative to the ilioinguinal and pararectal approaches, and may be regarded as an evolutionary advancement of traditional procedures.

Heterotopic Ossification Remodeling After Acetabular Surgery: A Natural History Case Report.

A 30-year-old woman presented with a transverse plus posterior wall acetabular fracture and underwent operative fixation through a Kocher-Langenbeck approach. Shared decision was made for no heterotopic ossification (HO) prophylaxis. The patient developed symptomatic HO and was scheduled for resection, which was delayed because of the pandemic. She returned with interval remodeling of HO and symptom resolution. No surgery was required. HO is a common complication after acetabular injury. Resection is the treatment of choice for symptomatic HO. We are not aware of other reports of spontaneous remodeling of symptomatic HO such that it no longer required surgery.

Open reduction, acetabular and femoral head fixation of Pipkin type IV fracture in an adolescent: A case report

AbstractBACKGROUND Femoral head fracture is extremely rare in adolescent. There are few studies that focus on cases treated of pipkin type IVCASE SUMMARY A 15-year-old male adolescent suffered a serious traffic accident when he was sitting on the front seat of car. Several hours after accident at the local hospital, he diagnosed as posterior dislocation of the right hip with drop foot , and treat closed reduction immobilisation with skin traction. After first operation he transferred to another hospital. Pelvic radiograph computed tomography revealed a head femoral fracture and large acetabular rim fracture. This was diagnosed as a Pipkin type IV acetabular and femoral head fracture with dislocation. An open reduction Inion Freedom bioscrew fixation of head femur and 4.5 cortical screw fixation of acetabular fracture was performed via a Kocher Langenbeck approach. After 1-year follow-up, the patient could walk without aid and participate in physical activities. The X-ray results showed that the fractures healed well with no evidence of complications.CONCLUSION Open reduction, fixation both acetabular and femoral head is an available therapy to treat Pipkin type IV in adolescent

Primary joint replacement for the treatment of acetabular fractures

Open reduction and internal fixation are the gold standard for the treatment of dislocated acetabular fractures. Aprimary joint replacement is only justified in isolated cases. The indications are merely non-reconstructable acetabular fractures, accompanying displaced fractures of the femoral neck and non-reconstructable fractures of the femoral head.Because of the difficulties in achieving sufficient cup stability, joint replacement for the treatment of acetabular fractures regularly requires implants designed for revision arthroplasty. The Kocher-Langenbeck approach provides the most versatile options, as it enables simultaneous stabilization of the dorsal acetabular structures, which are essential for the stability of the cup.For primary joint replacement as atreatment of acetabular fractures, survival of the prosthetic cup is markedly worse when compared to elective primary joint replacement. Particularly in younger patients but also in aged patients, every effort should be made to achieve apress fit of the cup. In most cases, this will include reduction and fixation of the fracture for stabilization of the acetabulum prior to joint replacement. Astaged approach with an early secondary replacement intervention seems to provide better overall results than simultaneous fracture fixation and joint replacement.

Short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures

To investigate the short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures. Between January 2015 and January 2020, 30 patients with complex acetabular fractures were treated with reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach. There were 20 males and 10 females with an average age of 52.1 years (range, 25-71 years). The cause of injury included traffic accident in 17 cases and falling from height in 13 cases. Among them, 14 cases were left acetabular fractures and 16 cases were right acetabular fractures. According to Letournel classification, there were 16 cases of double column fractures, 2 cases of transverse fracture with posterior wall fracture, 4 cases of anterior column and posterior hemi-transverse fractures, 8 cases of T-shaped fracture. The displacement distance of fracture ranged from 6 to 30 mm (mean, 11.6 mm). The time from injury to operation was 6-14 days (mean, 8.7 days). The operation time was 2.0-4.5 hours (mean, 3.0 hours). The intraoperative blood loss was 200-800 mL (mean, 450.0 mL). All patients were treated with autologous blood transfusion during operation. All incisions healed by first intention after operation, and no infection occurred. All patients were followed up 12-15 months (mean, 13.4 months). The drainage tube was removed at 2-3 days after operation. After extubation, X-ray film and three-dimensional CT were performed to recheck the fracture reduction. According to Matta score system, 20 cases were excellent, 5 were good, and 5 were poor, the excellent and good rate was 83.3%. All fractures healed with the healing time of 16-25 weeks (mean, 17.7 weeks). According to Merle d'Aubigne-Postel score system, the hip function at 1 year after operation was rated as excellent in 18 cases, good in 6 cases, and fair in 6 cases, and the excellent and good rate was 80.0%. Two cases suffered from sciatic nerve injury due to traction during operation, 7 cases had heterotopic ossification, 2 cases had traumatic hip arthritis, and no other complications occurred. For complex acetabular fractures, the reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach can obtain good short-term effectiveness with good reduction and hip joint function, and less complications.

Evaluation of the Results of Open Reduction and Internal Fixation of Posterior Wall and Posterior Column Fracture of Acetabulum by Reconstruction Plate and Screw by Kocher-Langenbeck Approach

Background: Historically, acetabular fracture therapy was generally insufficient, leaving many patients with incapacitating pain, mobility limitations, and joint failure. It's caused by high-velocity injuries and affects young, economically productive people. Proper treatment including optimum surgical care should be offered, especially in our uninformed and fiscally unstable society, to preserve lives and reduce long-term consequences and impairments. This research aims to examine and manage the posterior wall and column of acetabular fracture, focusing on aspects the treating physician may influence. Objectives: To assess the outcome of open reduction and internal fixation of posterior wall and column fracture of acetabulum which may help the orthopaedic surgeons to take appropriate measures as needed. Materials and Methods: 15 posterior acetabular fracture patients were studied. Cases were clinically and radiologically diagnosed in NITOR's emergency or outpatient departments (NITOR). All patients had open reduction and internal fixation by Kocher-Langenback technique. 1 hour 55 minutes was average operating time 21-day average hospital stay. Per- and post-op were uneventful. Patients were released with follow-up appointments. Patients were clinically and radiologically examined at each follow-up. Results: Most injuries were from RTAs (86.66 percent ). Most patients had left acetabular injuries (66.66 percent). Posterior wall acetabular fractures were more common (53.33%) than posterior column and wall fractures (33.33 percent). Most patients had surgery within 2 weeks after injury (60 percent ). 4 (26.66%) and 6 (40%) patients had good clinical and radiological outcomes following surgery. Most patients' clinical (46.66%) and radiological outcomes were favorable (53.33 percent). About 20% of patients were clinically and radiologically fair. 6.6% of patients had poor physical result, while none had poor radiological outcome. 20-40-year-olds had a largely ..........

Treatment of complex acetabular fractures with improved Stoppa combined with Kocher-Langenbeck approach assisted by 3D printing technology

To explore the clinical effect of the modified Stoppa combined with Kocher-Langenbeck(K-L) approach and 3D printing technology in the treatment of complex acetabular fractures. The surgical methods of 70 patients with complex acetabular fractures admitted from April 2013 to July 2019 were retrospectively analyzed. Among them, 25 cases were operated with 3D printing technology(3D printing group) and 45 cases were operated with conventional operation(conventional operation group). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, complications and functional recovery of the hip joint of two groups were recorded. There were statistically significant differences between two groups in terms of operation time, intraoperative bleeding volume and intraoperative fluoroscopy times(P<0.01). All patients were followed up for (15.8±3.5) months, and all patients achieved bony healing. There was no significant difference in the results of Matta reduction between two groups(P>0.05). There was no significant difference in Harris score at 6 months after operation between two groups(P>0.05). With the aid of 3D printing technology, the improved Stoppa combined with K-L approach is used to treat complex acetabular fractures. It has certain advantages in helping clinicians to formulate a reasonable operation plan before operation, avoid unnecessary operation and trauma during operation, shorten the operation time and reduce the amount of bleeding during operation. It can improve the safety during the perioperative period, facilitate the accurate reduction of fractures during operation and facilitate the recovery of patients.

Comparison of clinical efficacy of subchondral blocking technique combined with plate-screw biplanar fixation and simple plate-screw support peripheral block fixation in the treatment of complex posterior wall acetabular fracture

To investigate the clinical effect of subchondral blocking technique combined with plate and screw biplane fixation in the treatment of complex acetabular posterior wall fractures. From July 2015 to December 2019, a total of 47 cases of acetabular posterior wall fractures were treated. According to the different internal fixation techniques, they were divided into the external blocking fixation group supported by lateral plate and screw(control group of 23 cases) and the subchondral blocking technique combined with lateral plate and screw support biplane fixation group(study group of 24 cases). In the control group, there were 15 males and 8 females, aged 18 to 68 years old with an average of (40.9±7.2) years;preoperative preparation was 4 to 13 days with an average of (7.9±1.5) days. In the study group, there were 14 males and 10 females, aged 20 to 71 years old with an average of (41.7±7.9) years;preoperative preparation was 4 to 12 days with an average of (7.5±1.9) days. Kocher-Langenbeck approach was used in both groups and all patients were followed up for at least 1 year. The operation time, intraoperative blood loss, hospitalization time, quality of fracture reduction after operation, modified Merle D'Aubigne Postel score of hip joint one year after operation and postoperative complication rate of two groups were statistically analyzed and compared. The patients in both groups were followed up for at least 1 year. One year after operation, the Merled'Aubigne Postel score(16.042±1.517) of hip function improvement in the study group was significantly higher than that in the control group (14.696±1.222)(P<0.05). There was no significant difference in operation time and intraoperative bleeding between the two groups(P>0.05). One year after operation, there was a significant difference between two groups in the evaluation results of Matta fracture reduction quality(P<0.05). There was no significant difference in postoperative complications between two groups(P>0.05). The treatment of complex acetabular posterior wall fracture with subchondral blocking technique combined with plate and screw biplane fixation technique has lower postoperative complication rate, better functional recovery of hip joint and satisfactory clinical effect.

Acetabulum fractures. Analysis of treatment results

Treatment of patients with acetabulum fractures (AF) remains a big challenge for orthopaedists and traumatologists. Suchfractures are known for their complications that lead to disability. Objective. To analyze the results of treatment of patientswith AF and complications that arise depending on the of the injury mechanism and the method of treatment, to evaluate the effectiveness available methods of preventing the development of these complications. Methods. A retrospective study wasdone on the basis of 89 AF patients analysis (age 17‒75 years, 22 women and 67 men) with different terms after the fracture.The majority of patients got primary care in other clinics. Diagnostic measures: clinical examination; X-ray examinationof the pelvis, that under conditions of acute injuries were supplemented with CT scan; ultrasound of abdominal cavity,chest X-ray, brain MRI, electroneuromyography of the lower limbs. Results. Most AF occurred as a result of traffic accidents.The most common types are A1 and B1 according to the classification of AO/ASIF. The system of skeletal traction has beenapplied often at the stage of primary treatment. During surgical treatment the Kocher-Langenbeck approach and osteosynthesis was mainly used to stabilize the posterior wall and acetabulum column. The typical complications of AF are coxarthrosis, femoral head aseptic necrosis despite the chosen treatment tactics. Their clinical manifestation with the hip impaired function occurred within a year after the trauma. Defined complications led to the need for total hip replacement in 67 (75.3 %) cases out of 89. In 8 patients, total hip replacement was performed in the acute period of injury and it was possible to restore the joint function with better early functional results compared to the rest of the patients. Conclusions. Primary total hip replacement in the case of AF is an effective treatment measure that gives the posibility restore the function of the hip joint in the shortest time and prevent the development of typical complications.

Posterior Exposure in Kocher-Langenbeck With Gluteus Minimus Debridement vs. the Gibson Approach: A Cadaveric Study.

To quantify the posterior acetabular exposure achieved with the Kocher-Langenbeck (K-L) with gluteus minimus debridement and Gibson approaches. A Kocher-Langenbeck approach and a subsequent Gibson approach on the contralateral hip were performed in the prone position on 9 fresh frozen cadavers. Calibrated digital images were obtained of the Kocher-Langenbeck exposure, Kocher-Langenbeck exposure after gluteus minimus debridement, and Gibson exposure. The surface area of the posterior hip and pelvis visualized with each approach was calculated and compared with the contralateral side to assess for the difference between exposures. In 5 of the 9 cadavers, the Kocher-Langenbeck exposure before gluteus minimus debridement yielded an increased exposure in comparison with the Gibson approach, and the exposure was equivocal in 3 specimens. An increase of greater than 10% was considered significant. The exposure increased anteriorly and cranially by an average of 13.1 cm 2 after debridement of the gluteus minimus caudal to the superior gluteal neurovascular bundle in the Kocher-Langenbeck approach. Debridement of the gluteus minimus caudal to the level of the superior gluteal neurovascular bundle can significantly increase anterior and cranial exposure in the Kocher-Langenbeck approach and provide similar areas of access when compared with that in the Gibson approach.

The use of suprapectineal plate in acetabular fractures via ilioinguinal approach with Stoppa window.

The aim of the study was to investigate the clinical results of open reduction and internal fixation using a suprapectineal buttress plate for specific acetabular fractures. We conducted a retrospective study involving thirty-three patients with specific acetabular fractures in an academic level 2 trauma center. We performed the ilioinguinal approach with Stoppa window for buttress plating of the quadrilateral surface. Clinical examination, radiographs and computed tomography were done using criteria described by Matta. Functional outcome was evaluated by visual analog scale (VAS), WOMAC, Harris Hip score modified, Hip disability and Osteoarthritis Outcome Score (HOOS) and modified Merle d'Aubignè scoring system. Average follow-up was 40.4 months with a minimum of 24 months. Mean age was 59.09 years. The 82% of patients were treated with a suprapectineal plate using ilioinguinal approach with Stoppa window. The 18% of patients required a Kocher-Langenbeck approach in order to get anatomic reduction of posterior wall or column. The 91% of patients were satisfied of their condition during activity of day living and only a small cohort reported walking aids. The worst clinical results were obtained in patients characterized by highest step displacement. Deep infection of surgical wound was observed in 6% of patients. In 3% of patients, one vascular injury occurred during surgery. Internal fixation using ilioinguinal approach with Stoppa window and a suprapectineal plate to buttress the quadrilateral plate should be considered a viable treatment of some acetabular fractures. Patients can expect a good functional outcome with a low complication rate.

Surgical Approaches for Acetabulum Fracture Treatment: Analytic Review

Background. The use of classical and modified surgical approaches to acetabulum is accompanied by serious intra- and postoperative complications associated with tissues, vessels, nerves, and lymphatic structures injury. The choice of approach to acetabulum affects the surgical time and the blood loss volume.&#x0D; The aim of the review was to compare the surgical time and blood loss volume using different surgical approaches to the acetabulum based on the relevant literature analysis.&#x0D; Methods. The search was carried out in PubMed/MEDLINE and Scopus databases from 1964 to 2022. When conducting a search for the phrases acetabular fractures, surgical approach to the acetabulum, 4368 articles were found. As a result of the selection, 12 publications containing the most complete information on the studied indicators were included in the quantitative analysis.&#x0D; Results. The data of surgical treatment of 540 patients with acetabulum fractures were analyzed. The average age of the patients was 45.211.6 years. Among the causes of pelvic and acetabulum fractures, road accident (70.4%) and falls from height (21.3%) largely prevailed. The blood loss depended on the use of specific approaches or their combination, and the surgical time. The shortest surgical time (101.027.0 min.) was required using pararectal approach, the longest (26456.4 min.) with the use of ilio-inguinal approach. The largest volume of blood loss was observed with Pfannenstiel approach 1057.1377.9 ml. No statistically significant differences were found when comparing the Kocher-Langenbeck (793328 ml), ilio-inguinal (82864 ml) and pararectal (798322 ml) approach. Performing the Kocher-Langenbeck approach in the patients lateral position reduces the surgical time by 16.8% and reduces blood loss by 12.4% compared to the patients prone position.&#x0D; Conclusion. Comparative clinical studies are required to determine the safest surgical approaches to the acetabulum, depending on the type of fracture, the mechanism of injury and the age of the patient.

The Outcomes and Revision Rate of Total Hip Arthroplasty in a Single Tertiary Center: A Retrospective Study

IntroductionTotal hip arthroplasty (THA) is a commonly performed and successful orthopedic practice procedure. However, failure of arthroplasty may require revision THA and pose substantial clinical challenges for orthopedic surgeons. Therefore, this retrospective study aimed to estimate the revision rate of THA and its risk factors at a tertiary care hospital.MethodsA retrospective cohort study was conducted in 2021 of patients who had undergone THA during 2016-2020 in a tertiary care hospital. All patients above 18 years old who had a THA were included in the study. The data was collected from patients' medical charts/electronic databases.ResultsA total of 148 THAs were included in this study. In total, 77 (52%) were females, and 71 (48%) were males. The average age of our patients was 49±17 years old, and the mean recorded BMI was 29.6. A total of 62% (n=92/148) of our participants were shown to have at least one comorbid disease, with hypertension being the most common comorbidity. Our findings show that half of the patients, 74 (50%), had a THA due to both primary and secondary osteoarthritis, 37 (25%) patients had avascular necrosis of the hip, and 25 (17%) were due to trauma. The most performed surgical approach was Kocher-Langenbeck (posterior) approach on 128 (86%), followed by the Hardinge (lateral) approach on 20 (13.51%). The most observed complication in the patients was postoperative pain in 35 (23.65%), followed by UTIs in 5 (3.38%). Of the 148 patients, nine (6.08%) had revision surgery. Regarding the revision rate, male patients were associated with a significantly higher rate of revision (P=<0.001), and older patients had a significantly increased risk of revision (P=0.026). Patients who developed complications, such as UTI, were associated with a higher revision rate (P=0.035). Also, a posterior approach (Kocher-Langenbeck) of the procedure was significantly linked to an increased risk of revision (P=0.014).ConclusionAll in all, there are multiple associated factors with an increased incidence of revision THA. For example, male patients, older patients, complication development during the hospital stay, and posterior surgical approach were all associated with a significantly higher rate of revision.

The direct posterior gluteal muscle splitting approach for posterior access to acetabular fractures: Surgical technique and case series

We present a minimally invasive direct posterior, gluteal muscle splitting approach (PMS) as an alternative to the traditional Kocher-Langenbeck (KL) approach for posterior access to acetabular fractures. We believe it offers significant advantages and provides improved access while maximizing the range of fracture patterns that can be addressed through a posterior approach.One hundred and eighty-four consecutive patients treated with this approach by the senior author (RMS) between 2001 and 2018 were reviewed. The most common individual fracture pattern addressed was a posterior wall (66/36%) but more complex combination fracture types were the dominant group (106/58%), and included transverse with posterior wall, posterior wall / posterior column, and T types. A radiographically congruent reduction was consistently obtained at surgery, without any operative sciatic nerve palsies and a comparable heterotopic bone formation rate to previous reports. We have reviewed all 120 patients who were followed beyond 6 months and noted the hip replacement conversion rates to be different with each fracture type. The rate was highest with Transverse/ posterior wall injuries (36%), 16% of the posterior wall injuries were converted, a history of dislocation was not specifically associated with conversion.We believe this approach improves the posterior access to the acetabulum, but this study also confirms the poor prognosis of specific groups of higher energy multi-fragmentary, posterior acetabular injuries and suggests the need for a classification system that better predicts the prognosis for the hip joint. Level of Evidence4

Evaluation of Socio-Demographic and Clinical Parameters after Open Reduction and Internal Fixation of Acetabulum Fractures

Background: The present study was done to evaluate the sociodemographic and clinical parameters after open reduction and internal fixation of acetabulum fractures. Material and methods: The present study was done in 44 patients of fracture acetabulum managed by open reduction internal fixation in the Department of Orthopaedic surgery, Indira Gandhi Medical College, Shimla. Results: There were 16 prospective (36.4%) and 28 retrospective (63.6%) cases. The mean age was 45.07 years with maximum number of 39 (88%) patients in the age group of 21- 60 years. Majority (77.3%) of the patients was males and 22.8 % were females. Forty three (97.7%) patients belonged to rural area and remaining 1(2.3%) patient belonged to urban area. Road traffic accident was the mode of injury in 63.6% patients followed by fall from height in 36.4%. Eighteen (41%) patients had posterior wall fracture followed by posterior wall with posterior column fracture was seen in 12 (27%). Average time interval between injury and surgery was 15 days (range 3-55 days). Thirty six percent of the patients were operated between 8-14 days and 34 % of patients between 0-7days. Thirty (68%) patients were operated by Kocher-Langenbeck approach in lateral position followed by 7 (15%) patients with ilioinguinal approach in supine position. Autogenous Bone graft was used in 31.7% of patients. Mean duration of hospital stay was 24 days (range 7-35 days). Conclusion: Study concluded that most of the patients were in the age group of 21- 60 years, males, belonged to rural area, injured due to Road traffic accidents, had posterior wall, operated within 15 days and were operated by Kocher-Langenbeck approach in lateral position.

Favorable Outcome Twenty-Two Months after Delbet Type Ib Capital Femoral Transepiphyseal Fracture and Posterior Column Acetabular Fracture in a Fifteen-Year-Old Male

Case A fifteen-year-old male patient sustained a posteriorly dislocated right capital femoral Delbet type Ib epiphyseal fracture-separation and a right acetabular posterior column fracture after a low-energy trip and fall. The capital femoral epiphysis was closed reduced and fixed with cannulated screws on an urgent basis. He underwent acetabular osteosynthesis via a Kocher-Langenbeck approach two days thereafter. Twenty-two months after injury, he was weight-bearing on the right lower extremity without radiologic evidence of avascular necrosis or clinical evidence of pain or functional deficit. Conclusion Fracture-separation of the capital femoral epiphysis comprises only 8% of skeletally immature femoral neck fractures in the Delbet and Colonna classification. Prognosis is worse with ipsilateral hip dislocation due to the risk of avascular necrosis from disruption of the medial femoral circumflex artery. Urgent referral to a trauma center and treatment by appropriate specialists enables good long-term results after this uncommon traumatic injury pattern.

Surgical treatment of acetabular fracture

The kocher -Langenbeck approach is the best suited approach for reduction and fixation of acetabular fracture that require fixation through posterior approach and provides sufficient access to the majority of posterior based acetabular fracture. Accuracy of fracture reduction is the strongest predictor of clinical outcome in acetabular fixation surgery.Twenty four patients with posteriorly based acetabular fracture were treated with open reduction and internal fixation using Kocher- Langenbeck incision. In our series, there were 11 posterior wall, 3 posterior column, 5 transverse, 2 posterior column and posterior wall and 3 transverse and posterior wall fractures. All the patients were in the age group of 30 to 45 years (mean age 38.5 years). Males dominated our series (n=18 i.e. 75%) and right side was more commonly involved in both the sexes (n=14 i.e. 58.33%). Road traffic accident was the leading cause (n=19 i.e. 79.16%). All the patients were operated achieving adequate stability and with utmost soft tissue care. Follow up radiograph were graded according to criteria developed by Matta J et al. A minimum follow up was two years. Patient with accurate reconstruction (n =21 i.e. 87.50%) had good or excellent functional outcome while two patients (08.33%) with inaccurate reduction and one patient (04.16%) with poor reduction had fair and poor outcome respectively. Despite relatively large number of possible complications Kocher–Langenbeck Approach is the best suited approach for posterior acetabular fracture.

The Impact of Surgical Approaches for Isolated Acetabulum Fracture on Sexual Functions: A Prospective Study.

To investigate the effects of surgical modalities for isolated acetabular fractures on the sexual functions of patients and their partners. Prospective. Level I trauma centre. Sixty-five patients who had undergone open reduction and internal fixation because of isolated acetabular fractures who were sexually active before, together with their partners. Patients operated on for isolated acetabular fractures were divided into 3 groups according to surgical approaches: the Kocher-Langenbeck approach (n = 36), ilioinguinal approach (n = 16), and modified Stoppa approach (n = 13). Sexual functions of patients and their partners were evaluated with the 5-item version of the International Index of Erectile Function score and Female Sexual Function Index score preoperatively and at the postoperative first year after the rehabilitation period. The mean age of the patients was 41.8 ± 13.0 (18-69) years. In male patients, the mean 5-item version of the International Index of Erectile Function score had changed from 24.3 to 20.0 at the postoperative first year and the decrease in sexual function scores was less with the Kocher-Langenbeck approach. In female patients, the Female Sexual Function Index scores had decreased statistically significantly from 24.9 to 18.3 at the postoperative first year, but there was no statistically significant difference between surgical groups. Both male and female patients' partners' sexual function scores were also decreased at the postoperative first year. As a result of our study, it was observed that the posterior approach is more advantageous than anterior approaches in preserving the sexual functions of male patients in acetabular fracture surgery. However, the surgical approach did not affect the sexual functions of female patients. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Clinical efficacy and its influencing factors of surgical treatment for T-shaped associated with posterior wall acetabular fractures\xa0using combined surgical approaches

BackgroundThe objective of this study was to evaluate the outcomes of surgical treatment for T-shaped associated with posterior wall acetabular fractures using combined surgical approaches and its influencing factors.MethodsBetween January 2009 and June 2018, a total of 21 patients with T-shaped acetabular fractures involving posterior wall were treated with combined approaches. The combined approaches were a combination of the Kocher-Langenbeck (KL) approach and the anterior approach (Stoppa or Ilioinguinal). The acetabular fractures in this study were divided into two groups respectively according to surgical approach and surgical timing: KL + Ilioinguinal (IL) approaches and KL + Stoppa approaches, early surgery and late surgery.Results13 cases were treated within 14 days of injury. 15 cases were treated using the KL + Stoppa approaches and remaining 6 cases were treated using the KL + IL approaches. Anatomical and imperfect reduction were achieved in 12 cases (57.1%) with excellent to good clinical outcome in 42.9% of cases. Early surgery had a statistically significant improvement over late surgery in terms of quality of reduction and clinical outcomes. In the early surgery, the incidence of preoperative chest and abdomen injuries and postoperative deep vein thrombosis was significantly lower than that of the late surgery. There was no statistical difference between the KL + IL approaches and KL + Stoppa approaches in the demographics, preoperative associated injuries, quality of reduction, clinical outcomes and postoperative complications.ConclusionsThe results of this study indicate that T-shaped associated with posterior wall acetabular fractures are difficult to treat surgically. Early surgery can improve the quality of fracture reduction, promote the recovery of hip function, and decrease the incidence of postoperative deep vein thrombosis. The main factor that affects surgical timing is the presence of preoperative chest and abdominal injuries. Compared with the KL + IL approaches, the KL combined with Stoppa approach can not significantly improve the clinical outcomes of such acetabular fractures.