Comparative cadaveric study of the Kocher-Langenbeck approach with and without trochanteric osteotomy in extended posterior wall fractures of the acetabulum.

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Tác giả: Chulin Chewakidakarn, Kantapon Dissaneewate, Surasak Jitprapaikulsarn, Apipop Kritsaneephaiboon, Wich Orapiriyakul, Mukta Waewwanjit

Ngôn ngữ: eng

Ký hiệu phân loại:

Thông tin xuất bản: Germany : Archives of orthopaedic and trauma surgery , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 109432

INTRODUCTION: Standard exposure, such as the Kocher-Langenbeck (KL) approach, has a limited ability to access the cranial and anterior portions of the posterior wall with an extended fracture line into the acetabular dome. Augmentation of the KL approach with trochanteric osteotomy (TO) enhances the exposure in this area. We compared the area of surgical exposure in the KL approach with and without additional TO and identified the most anterior exit point of the posterior wall in each surgical approach. MATERIALS AND METHODS: Ten fresh cadaveric hip specimens were used. The KL approach was initially used for each specimen, followed by additional TO. Surgical exposures were marked, and measurements were taken for anterior and cranial exposure distances, surface area of bony exposure, and posterior wall arc angle (PWAA). RESULTS: TO significantly increased the anterior exposure distance (65.83 vs. 49.07 mm) and acetabular surface area (43.95 vs. 33.51 cm CONCLUSION: The KL approach with TO significantly improved surgical exposure for posterior wall acetabular fractures, especially in the anterior regions. For fractures with a PWAA of 0º-27º, the KL approach alone (in the prone or lateral decubitus positions) is sufficient. If the PWAA is between 27º and 52º, the KL approach in the lateral decubitus position is recommended, with TO planned, if necessary. For fractures with a PWAA greater than 52º, the KL approach with additional TO in the lateral decubitus position is recommended. LEVEL OF EVIDENCE: IV, cadaveric study.
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