Modified "2-portal" kocher-langenbeck approach: a minimally-invasive procedure protecting the short external rotator muscles.

Acetabular fractures rank among the most challenging reconstruction procedures in trauma surgery. Thereby, substantial muscle dissection can result in functional limitations. In this study, a muscle-protecting modification of the standard Kocher-Langenbeck approach is described. A prospective clinical analysis was performed on 18 patients who underwent surgery for acetabular fractures. Nine patients were treated by the presented modified approach and another 9 patients by a standard Kocher-Langenbeck approach. The modification, which is described in this study, protects the small rotator muscles, leaving them attached at both ends. Hip muscle strength was measured, and gait analysis and a subjective follow-up were done. The muscle strength measurements in the modified group indicate an increase for the injured side, whereas in the standard group, the operated side decreased. Even when the muscle strength, the gait analysis, and the short musculoskeletal function assessment test showed no statistical difference, the operation time was even lower in the modified group. The fracture reduction was good and did not seem to have additional approach-related complications.