Standard Approaches to the Acetabulum Part 1: Kocher-Langenbeck Approach

CURRENT CONCEPTS REVIEW SOUBORNÝ REFERÁTproaches and 12,4% extended approaches (6).More recent data from the years 2005-2007, showed that anterior approaches are now predominantly used according to a higher number of acetabular fractures with anterior column involvement.Overall, more than 40% of all patients with acetabular fractures are still approached via the Kocher-Langenbeck approach (18).Therefore, the Kocher-Langenbeck approach is still a "working horse" in approaching displaced acetabular fractures.The Kocher-Langenbeck approach consists of two parts.In 1874 von Langenbeck described a longitudinal incision starting from above the greater sciatic notch to the greater trochanter, dissecting the gluteal muscles for treating hip joint infections (11).Theodor Kocher in 1911 described a curved incision starting from the posterior-inferior corner of the greater trochanter, running across the postero-superior tip of the greater trochanter passing oblique in line with the fibres of the gluteus maximus muscle in direction to the posterior superior iliac spine (10).The aim of the present analysis is the detailed anatomical analysis of this standard approach, focusing on fracture indication, positioning of the patient, exposure, dissection, reduction techniques of special fracture types, approach modifications/extensions, complications and approach-specific results.