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.

The Ilioinguinal Approach: State of the Art.

INTRODUCTION: The ilioinguinal approach is the standard approach for the open reduction and internal fixation of the majority of displaced, anteriorly based acetabular fractures as it offers wide access to the acetabulum, is extensile, and has been associated with enhanced recovery. STEP 1 PREOPERATIVE PLANNING: Review the patient's general condition and imaging studies and plan the sequence of reduction and fixation. STEP 2 PREPARATION AND PATIENT POSITIONING: Position the patient supine on the fracture table, induce anesthesia, prepare the surgical field, administer intravenous antibiotics, and apply traction. STEP 3 ILIOINGUINAL APPROACH: Make a long curvilinear incision over the affected lower flank, develop the 3 working windows, and reduce and stabilize the fracture while protecting the neurovascular structures and the bladder (Video 2). STEP 4 FRACTURE REDUCTION AND FIXATION: For reduction of a both-column acetabular fracture, connect the mobile parts of the acetabulum to the iliac segment that is attached to the sacrum, noting that, in most cases, the usual sequence involves the reduction of the anterior column to the intact ilium followed by the reduction of the posterior column (Video 7). STEP 5 WOUND CLOSURE AND POSTOPERATIVE AFTERCARE: Perform meticulous hemostasis, apply drains, and ensure watertight closure, which are the final steps of the operation (Video 8). RESULTS: The ilioinguinal approach remains 1 of the standard approaches for the management of acetabular fractures10.