title: Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management.
abstract: BACKGROUND
  Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. Adequate visualization of some acetabular fracture types may necessitate extensile or combined anterior and posterior approaches. Simultaneous anterior iliofemoral and posterior Kocher-Langenbeck (K-L) exposures with two surgical teams have also been described. To assess whether modified Kocher-Langenbeck (K-L) approach can substitute standard K-L approach in the management of elementary acetabular fractures other than the anterior wall and anterior column fractures and complement anterior surgical approaches in the management of complex acetabular fractures.
  
  
  METHODS
  20 patients with transverse and associated acetabular fractures requiring posterior exposure were included in this prospective study. In 9 cases (7 transverse, 1 transverse with posterior wall, and 1 posterior column with posterior wall), stabilization was done through modified K-L approach. In 11 cases (3 transverse and 8 associated fractures), initial stabilization through iliofemoral approach was followed by modified K-L approach.
  
  
  RESULTS
  The average operative time was 183 min for combined approach and 84 min for modified K-L approach. The postoperative reduction was anatomical in 17 patients and imperfect in 3 patients. The radiological outcome was excellent in 15, good in 4, and poor in one patient. The clinical outcome was excellent in 15, good in 3 and fair and poor in 1 each according to modified Merle d'Aubigne and Postel scoring system.
  
  
  CONCLUSIONS
  We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team.
authors.affiliation: Department of Orthopaedics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.
authors.forename: Narender Kumar
authors.initials: NK
authors.lastname: Magu
authors.affiliation: Department of Orthopaedics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rohilla
authors.affiliation: Department of Orthopaedics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.
authors.forename: Amanpreet
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Orthopaedics, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.
authors.forename: Jitendra
authors.initials: J
authors.lastname: Wadhwani
keywords: Acetabular fractures; Acetabulum; Kocher-Langenbeck approach; bone; fracture; fracture fixation; iliofemoral approach; ilioinguinal approach; modified Kocher-Langenbeck appropach; transverse fractures