The Kocher-Langenbeck Approach: State of the Art.

INTRODUCTION: The Kocher-Langenbeck approach is the workhorse for the reduction and fixation of hip fractures that require fixation via a posterior approach1,2. STEP 1 PREOPERATIVE PLANNING: Review the patient's general condition and imaging studies, plan the sequence of reduction and fixation, and make sure that all of the necessary equipment is available. STEP 2 PREPARATION AND PATIENT POSITIONING: Induce anesthesia, administer intravenous antibiotics as per local hospital protocol, apply antiembolism stockings, and insert a Foley catheter to the bladder. STEP 3 KOCHER-LANGENBECK APPROACH: Make an incision that is 15 to 20 cm long and has 2 parts (proximal and distal), which are centered over the greater trochanter. STEP 4 FRACTURE REDUCTION AND FIXATION: The reconstruction of posteriorly based fractures depends on the specific fracture type, and the goal is to provide stable column fixation and anatomical reconstruction of the acetabular articular surface, with column fixation performed before the reconstruction of the posterior wall. STEP 5 WOUND CLOSURE AND POSTOPERATIVE CARE: Meticulous hemostasis, application of drains, and watertight closure are the final steps of the operation.
RESULTS: The Kocher-Langenbeck approach is the workhorse for the surgical management of acetabular fractures and provides sufficient access to the majority of posterior based acetabular fractures15.