- See:
Kocher Langenbock for Acetabular Frx:
- Discussion:
- position pt prone, on a radiolucent table;
- vertical incision placed 2 cm lateral to posterosuperior spine;
- mobilize gluteal muscles from their origins on iliac wing & sacrum;
- mobilize piriformis from greater
sciatic notch to allow palpation can
be performed anteriorly along sacrum and
sacroiliac joint;
- reflect posterior portion of gluteus from posterior iliac wing;
-
maximus origin is also reflected from sacrum;
- greater sciatic notch must be exposed for assessment of the reduction;
- w/
sacral frx, frx is visualized on posterior sacral lamina;
- place pointed reduction forceps from sacrum to iliac wing for reduction;
- palpation thru
greater sciatic notch as well as visualization of the
most inferior portion of the
SI joint give keys to reduction;
- flouroscopy is needed used to place screws perpendicular to iliac wing
across the
SI joint into the sacral ala;
- screws are directed toward the S1 vertebral body;
- complications of posterior approach:
- posterior incisions in acute trauma situation have resulted in
unacceptably high rate of
skin necrosis;
- even w/o posterior incisions, there may be skin breakdown in many
pts w/ severe unstable
vertical shear injuries;
- at surgery,
gluteus maximus muscle is often torn from its insertion
leaving no underlying fascia to nourish skin;
