Modified Kocher-Langenbeck approach for the stabilization of posterior wall fractures of the acetabulum.

This article describes a modification of Kocher-Langenbeck approach for the treatment of select posterior wall fractures of acetabulum. The technique aims at achieving osteosynthesis by creating two windows: between the gluteus medius and piriformis superiorly and between the external rotators and ischial tuberosity inferiorly. The approach spares the division of external rotators and of the abductors of the hip, thus preventing iatrogenic damage to the vascularity of the head of the femur and of the fracture fragments. The reconstruction plate can be slid under the piriformis and the short external rotators, thus preserving the soft tissue sleeve of the hip posteriorly. The gluteus minimus is not stripped from the ilium. The technique is ideally suited for isolated, displaced, noncomminuted posterior wall fractures of acetabulum of less than 10 days' duration without marginal impaction. The technique is biologic, takes a shorter operative time in our hands, and prevents further damage to vascularity of the head of the femur and heterotopic ossification.