Type to search

Acetabular Fractures: The Kocher-Langenbeck approach

It is a fact that acetabular fractures are rare injuries. It is estimated that 3 out of 100 000 inhabitants suffer one each year.

However, since elderly patients are becoming more proactive regarding their physical activity, it is estimated that those fractures will increase.

Usually, acetabular fractures happen from a fall of a significant height or as result of a vehicle accident. They are considered to be serious injuries and often occur in multiple trauma patients, except for osteoporotic patients, whose fragile acetabular may fracture from a simple low-energy fall from standing height.

The type and displacement of an acetabular fracture are determined by the position of the femur at the time of impact and the direction of the force.

Over the years, the management of this type of fracture has been changing from conservative to operative.

Gender is not supposed to influence the outcome of acetabular surgery.However, the surgeon’s know-how and the approach chosen for a given acetabular fracture may influence the outcome.

A case study was made in order to identify surgeon-independent and approach-specific parameters as prognostic factors for radiographic outcome and early complication rates of acetabular fractures treated with the Kocher-Langenbeck approach.

The study focused on the “radiographic outcome and early complications of all trauma victims suffering high-energy fractures, who had been treated with ORIF by a single surgeon, the senior author D.S., at a single level I trauma center within a time period of 10 years through an isolated Kocher-Langenbeck approach”.

People who presented “manifestation of severe osteoporosis, low-energy trauma, pathological fractures, and previous history of hip injuries, as well as dementia and other disease processes (…)” were excluded.

It was all about data…

  • A total of 167 consecutive patients underwent surgical treatment;
  • A total of 68 procedures were performed in the lateral position and 99 in the prone position;
  • 65.5% of the patient population were men and 33.5% women;
  • The mean age was of 48 years old;
  • The side of the injury was the left in 75 patients and the right in 92 patients;
  • The mean time from accident to surgery was 4 days;
  • The mean time from patient entering the operating room to skin incision was 60 minutes;
  • The surgeries lasted about 157 minutes;
  • The median estimated intraoperative blood loss was 300 ml;
  • Anatomic reduction was achieved in 106 patients;
  • Imperfect and poor reduction was achieved in 37 and 24 patients, respectively;
  • Excellent or good results were reported in 89% of the patients with anatomic reduction, and 53% of the patients with poor reduction had poor clinical results.

Anatomic reduction is directly related to posttraumatic arthrosis and decreases its incidence. Posttraumatic arthritis was considered the primary complication following an acetabular fracture and it might lead to a total hip replacement.

It was also concluded that race is an important factor: African American patients revealed a tendency to develop severe heterotopic ossification when compared to Caucasian patients.

Within all the complications, only posttraumatic arthritis and the occurrence of post-operative hemorrhagic shock differed significantly depending on the fracture type.

All the patients were subdivided into three age groups: up to 40, between 40 and 60 years and above 60 years, and age-related differences were reported in fracture types. Patient age was reported to be related with the accuracy of reduction in several studies.

Infections, revision surgery, need of a total hip arthroplasty, avascular necrosis of the femoral head and posttraumatic arthritis occur significantly more often in older patients, as indicated in this study. Age can also be related to negative outcomes after ORIF of acetabular fractures with high probability.

Most of the patients did not return for the follow-up examination, possibly because they were satisfied with their surgeries and did not need any further treatment.

Either way, acetabular fractures are rare injuries in a heterogeneous patient population. You can identify any fracture type, gender and age prognostic factors or the outcome after ORIF using the Kocher-Langenbeck approach.

There are many fracture types that require different treatments;  as such, the presented results depend on the patient selection.

Why is Pre-Operative Planning so Important for Surgery?

Orthopedic Surgery Blog
Copy link
Powered by Social Snap