INDICATIONS AND OUTCOMES OF THE KOCHER-LANGENBECK SURGICAL APPROACH IN THE MANAGEMENT OF ACETABULAR FRACTURES IN A RESOURCE LIMITED SETTING

Indications and Outcomes of the Kocher-Langenbeck Surgical Approach in the Management of Acetabular Fractures in a Resource Limited Setting

Handy ED^1*, EK Ndifor¹, AM Itambi¹, Mbaga AC¹, Ndikum BN², Fonkoue L³, Muluem K⁴, Guifo ML⁵, MA Sosso⁶

¹Orthopeadics and Trauma Unit, Yaounde Central Hospital. ¹Orthopeadics and Trauma Unit, Yaounde Central Hospital. ¹Orthopeadics and Trauma Unit, Yaounde Central Hospital. ¹Orthopeadics and Trauma Unit, Yaounde Central Hospital. ²Public Health Expert, Elig-Essono Sub-Divisional Medical Centre. ³Orthopeadics and trauma unit, Yaounde Emergency Centre. ⁴Orthopeadics and Trauma Unit, Yaounde General Hospital. ⁵Orthopeadics and Trauma Unit, Yaounde University Teaching Hospital. ⁶Head of Department, Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I.

The Kocher-Langenbeck (K-L) approach is the ‘workhorse’ of surgery for acetabular fractures needing posterior fixation. It is indicated for most of these fractures for proper surgical technique and optimal outcome. We therefore evaluated the outcome of surgically treated acetabular fractures through the K-L approach in our setting with limited resources. 57 patients were operated by the K-L approach during the 3-year study period. The most common indications of this approach were: posterior wall (38.6%) and transverse + posterior wall fractures (36.8%). Based on Matta’s criteria of fracture reduction, 81 % were judged anatomic, 16% imperfect and 3 % poor. A surgery waiting time of 8 to 14 days after injury, significantly favoured anatomic fracture reduction. The MAP score was excellent in 72 % and unacceptable in 10.6 %. Factors associated with poor outcomes were poor fracture reduction and the development of early post-operative complications. Iatrogenic sciatic nerve palsy (ISNP) was the most significant post-operative complication (19.3%). The levering of Hohmann retractors in the sciatic notches was the major risk factor for developing ISNP, compared to the use of sciatic nerve retractors. Other early and late complications included surgical site infections (12.3%) and heterotopic ossification (8.8 %), respectively. The overall outcome following surgery by the K-L approach is satisfactory. However, there is need to ameliorate the technique, especially at the level of instrumentation, to limit post-operative complications.

Keywords: Acetabular fractures, Kocher-Langenbeck approach, Outcome.

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How to cite this article:
Handy ED, EK Ndifor, AM Itambi, Mbaga AC, Ndikum BN, Fonkoue L, Muluem K, Guifo ML, MA Sosso. Indications and Outcomes of the Kocher-Langenbeck Surgical Approach in the Management of Acetabular Fractures in a Resource Limited Setting. American Journal of Orthopedic Research and Reviews, 2022, 5:30. DOI: 10.28933/ajorr-2021-11-2805

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