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Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management

BACKGROUND: Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. Adequate visualization of some acetabular fracture types may necessitate extensile or combined anterior and posterior approaches. Simultaneous anterior iliofemoral and posterior...

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Autores principales: Magu, Narender Kumar, Rohilla, Rajesh, Singh, Amanpreet, Wadhwani, Jitendra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800965/
https://www.ncbi.nlm.nih.gov/pubmed/27053812
http://dx.doi.org/10.4103/0019-5413.177570
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author Magu, Narender Kumar
Rohilla, Rajesh
Singh, Amanpreet
Wadhwani, Jitendra
author_facet Magu, Narender Kumar
Rohilla, Rajesh
Singh, Amanpreet
Wadhwani, Jitendra
author_sort Magu, Narender Kumar
collection PubMed
description BACKGROUND: Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. Adequate visualization of some acetabular fracture types may necessitate extensile or combined anterior and posterior approaches. Simultaneous anterior iliofemoral and posterior Kocher-Langenbeck (K-L) exposures with two surgical teams have also been described. To assess whether modified Kocher-Langenbeck (K-L) approach can substitute standard K-L approach in the management of elementary acetabular fractures other than the anterior wall and anterior column fractures and complement anterior surgical approaches in the management of complex acetabular fractures. MATERIALS AND METHODS: 20 patients with transverse and associated acetabular fractures requiring posterior exposure were included in this prospective study. In 9 cases (7 transverse, 1 transverse with posterior wall, and 1 posterior column with posterior wall), stabilization was done through modified K-L approach. In 11 cases (3 transverse and 8 associated fractures), initial stabilization through iliofemoral approach was followed by modified K-L approach. RESULTS: The average operative time was 183 min for combined approach and 84 min for modified K-L approach. The postoperative reduction was anatomical in 17 patients and imperfect in 3 patients. The radiological outcome was excellent in 15, good in 4, and poor in one patient. The clinical outcome was excellent in 15, good in 3 and fair and poor in 1 each according to modified Merle d’Aubigne and Postel scoring system. CONCLUSION: We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team.
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spelling pubmed-48009652016-04-06 Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management Magu, Narender Kumar Rohilla, Rajesh Singh, Amanpreet Wadhwani, Jitendra Indian J Orthop Original Article BACKGROUND: Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. Adequate visualization of some acetabular fracture types may necessitate extensile or combined anterior and posterior approaches. Simultaneous anterior iliofemoral and posterior Kocher-Langenbeck (K-L) exposures with two surgical teams have also been described. To assess whether modified Kocher-Langenbeck (K-L) approach can substitute standard K-L approach in the management of elementary acetabular fractures other than the anterior wall and anterior column fractures and complement anterior surgical approaches in the management of complex acetabular fractures. MATERIALS AND METHODS: 20 patients with transverse and associated acetabular fractures requiring posterior exposure were included in this prospective study. In 9 cases (7 transverse, 1 transverse with posterior wall, and 1 posterior column with posterior wall), stabilization was done through modified K-L approach. In 11 cases (3 transverse and 8 associated fractures), initial stabilization through iliofemoral approach was followed by modified K-L approach. RESULTS: The average operative time was 183 min for combined approach and 84 min for modified K-L approach. The postoperative reduction was anatomical in 17 patients and imperfect in 3 patients. The radiological outcome was excellent in 15, good in 4, and poor in one patient. The clinical outcome was excellent in 15, good in 3 and fair and poor in 1 each according to modified Merle d’Aubigne and Postel scoring system. CONCLUSION: We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4800965/ /pubmed/27053812 http://dx.doi.org/10.4103/0019-5413.177570 Text en Copyright: © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Magu, Narender Kumar
Rohilla, Rajesh
Singh, Amanpreet
Wadhwani, Jitendra
Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management
title Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management
title_full Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management
title_fullStr Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management
title_full_unstemmed Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management
title_short Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management
title_sort modified kocher-langenbeck approach in combined surgical exposures for acetabular fractures management
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800965/
https://www.ncbi.nlm.nih.gov/pubmed/27053812
http://dx.doi.org/10.4103/0019-5413.177570
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