BACKGROUND: Open reduction and internal fixation through the Kocher-Langenbeck approach is the treatment of choice for selected acetabular fracture patterns. Patient positioning (lateral vs prone) can affect the outcome and post-operative complications. METHODS: A retrospective cohort of seventy-three adult patients' with acetabular fractures treated with open reduction and internal fixation through the Kocher-Langenbeck approach in either prone or lateral position. Primary outcome was the quality of radiographic fracture reduction; secondary outcomes included operative time, intra-operative estimated blood loss and pre-operative complications. RESULTS: The demographics and fracture type were similar between the two groups. There was no difference in the quality of reduction using the Matta radiographic grading. Laterally positioned group demonstrated significant shorter surgical time and lower incidence of iatrogenic sciatic nerve injury. There was no difference in estimated blood loss, heterotopic ossification or infection. CONCLUSION: This study showed no difference in the quality of fracture reduction, intraoperative blood loss, post-operative infection and heterotopic ossification between both groups. Hence, patients' condition, surgeon experience and preference are important factors for deciding patient positioning in the Kocher-Langenbeck approach for acetabulum fracture fixation.
BACKGROUND: Open reduction and internal fixation through the Kocher-Langenbeck approach is the treatment of choice for selected acetabular fracture patterns. Patient positioning (lateral vs prone) can affect the outcome and post-operative complications. METHODS: A retrospective cohort of seventy-three adult patients' with acetabular fractures treated with open reduction and internal fixation through the Kocher-Langenbeck approach in either prone or lateral position. Primary outcome was the quality of radiographic fracture reduction; secondary outcomes included operative time, intra-operative estimated blood loss and pre-operative complications. RESULTS: The demographics and fracture type were similar between the two groups. There was no difference in the quality of reduction using the Matta radiographic grading. Laterally positioned group demonstrated significant shorter surgical time and lower incidence of iatrogenic sciatic nerve injury. There was no difference in estimated blood loss, heterotopic ossification or infection. CONCLUSION: This study showed no difference in the quality of fracture reduction, intraoperative blood loss, post-operative infection and heterotopic ossification between both groups. Hence, patients' condition, surgeon experience and preference are important factors for deciding patient positioning in the Kocher-Langenbeck approach for acetabulum fracture fixation.
Entities:
Keywords:
Acetabulum; Fracture; Internal fixation; Kocher–Langenbeck; Lateral; Open reduction; Prone
Authors: Lars Brouwers; Albert F Pull Ter Gunne; Mariska A de Jongh; Thomas J J Maal; Rinaldo Vreeken; Frank H W M van der Heijden; Luke P H Leenen; Willem R Spanjersberg; Sven H van Helden; Diederik O Verbeek; Mike Bemelman; Koen W W Lansink Journal: Eur J Orthop Surg Traumatol Date: 2019-09-17
Authors: Natasha M Simske; J Collin Krebs; Isabella M Heimke; Nicholas R Scarcella; Heather A Vallier Journal: J Orthop Trauma Date: 2019-12 Impact factor: 2.512