Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach.

Détails

ID Serval
serval:BIB_813047A86D55
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach.
Périodique
Journal of Orthopaedic Trauma
Auteur(s)
Siebenrock K.A., Gautier E., Ziran B.H., Ganz R.
ISSN
0890-5339 (Print)
ISSN-L
0890-5339
Statut éditorial
Publié
Date de publication
1998
Volume
12
Numéro
6
Pages
387-391
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal ArticlePublication Status: ppublish
Résumé
OBJECTIVE: To describe the advantages and surgical technique of a trochanteric flip osteotomy in combination with a Kocher-Langenbeck approach for the treatment of selected acetabular fractures.
DESIGN: Consecutive series, teaching hospital.
METHODS: Through mobilization of the vastus lateralis muscle, a slice of the greater trochanter with the attached gluteus medius muscle can be flipped anteriorly. The gluteus minimus muscle can then be easily mobilized, giving free access to the posterosuperior and superior acetabular wall area. Damage to the abductor muscles by vigorous retraction can be avoided, potentially resulting in less ectopic ossification. Ten consecutive cases of acetabular fractures treated with this approach are reported. In eight cases, an anatomic reduction was achieved; in the remaining two cases with severe comminution, the reduction was within one to three millimeters. The trochanteric fragment was fixed with two 3.5-millimeter cortical screws.
RESULTS: All osteotomies healed in anatomic position within six to eight weeks postoperatively. Abductor strength was symmetric in eight patients and mildly reduced in two patients. Heterotopic ossification was limited to Brooker classes 1 and 2 without functional impairment at an average follow-up of twenty months. No femoral head necrosis was observed.
CONCLUSION: This technique allows better visualization, more accurate reduction, and easier fixation of cranial acetabular fragments. Cranial migration of the greater trochanter after fixation with two screws is unlikely to occur because of the distal pull of the vastus lateralis muscle, balancing the cranial pull of the gluteus medius muscle.
Mots-clé
Acetabulum/injuries, Acetabulum/radiography, Adult, Combined Modality Therapy, Female, Fracture Fixation, Internal/instrumentation, Fracture Fixation, Internal/methods, Fracture Healing/physiology, Fractures, Bone/radiography, Fractures, Bone/surgery, Humans, Male, Middle Aged, Muscle, Skeletal/surgery, Osteotomy/methods, Prognosis, Treatment Outcome
Pubmed
Web of science
Création de la notice
26/11/2012 20:23
Dernière modification de la notice
03/03/2018 18:47
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