Unstable Posterior Acetabular Fractures: Early Results of Delayed Reduction and Fracture Fixation Using the Kocher-Langenbeck Approach with Trochanteric Flip Osteotomy

Joseph L. Lai, Irewin A. Tabu and Majah S. Jacob

Section of Trauma, Department of Orthopedics, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

 

Unstable posterior acetabular fractures resulting from high energy trauma present major  challenges to any orthopedic surgeon especially if the treatment has been delayed.

Objective. The purpose of this paper is to describe the early results of delayed treatment of a series of patients with posterior acetabular fractures with concomitant hip dislocations, surgically approached using the Kocher-Langenbeck with a trochanteric flip osteotomy.

Methods. Five (5) male patiens (mean age 35.6 years, range 23-58 years) who sustained unstable posterior acetabular fractures, underwent surgical treatment using the Kocher-Langenbeck approach with the trochaneric flip osteotomy, during the period of May 2014 to October 2015. Clinical and radiographic evaluations of each patient where performed, while complications were documented.

Results. Mean follow-up was 8 weeks (range of 2-12 weeks). There was adequate exposure of the posterior and superior acetabulum in all patients. Post-operative radiographs in four of five patients were graded "anatomic," while hip range of motion of these four patients averaged 78.7% of the uninjured hip. One patient with "poor" reduction underwent a second operation to revise a failure of the initial fixation using the same surgical approach. No other complications were reported.

Conclusion. This modified approach provides adequate exposure of both posterior and superior acetabulum and also allows inspection of the articular surfaces of both acetabulum and femoral head, which are limited in the standard Kocher-Langenbeck approach. With excellent exposure, congruent reduction can readily be achieved while permitting early hip range of motion post-surgery.

Key Words: acetabular fractures, trochanteric flip osteotomy, Kocher-Langenbeck approach