OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF POSTERIOR WALL FRACTURES – KOCHER–LANGENBECK APPROACH

Indications

Fractures of:

• Posterior wall.

• Posterior column.

• Posterior column and wall.

• Transverse fractures.

• Transverse posterior wall and T-shaped fractures.

Pre-operative planning

Clinical assessment

• Examination of the injured limb is essential, including the soft tissue envelope.

• In cases of high-energy trauma examination for other potential associated injuries should be performed carefully.

• The Advanced Trauma Life Support (ATLS) evaluation protocol should be followed.

Radiological assessment

• Anteroposterior radiograph of the pelvis, as well as Judet views, can provide substantial diagnostic information in terms of fracture type and also indicate the need for emergency treatment (in cases of fracture dislocations of the femoral head) (Fig. 8.1a, b, c,).

• CT scan will supplement the plain radiographs and important additional information can be obtained for the pre-operative planning (Fig. 8.2a,b,c).

Timing of surgery

• Operative treatment is generally delayed for 3–5 days to allow stabilization of the patient's general status.

• Two to four units of blood should be made available, depending on the extent of the fracture pattern.

Indications for emergency acetabular fracture fixation

• Recurrent hip dislocation after reduction despite traction.

• Progressive sciatic nerve deficit after closed reduction

• Irreducible hip dislocation.

• Associated vascular injury requiring repair.

• Open fractures.

Anaesthesia

• General anaesthesia at induction.

• Administration of prophylactic antibiotics as per local hospital protocol.