Govind Mohan Jee

Abstract

Background: The kocher -Langenbeck approach is the best suited approach for reduction and fixation of acetabular fracture that require fixation through posterior approach and provides sufficient access to the majority of posterior based acetabular fracture. Accuracy of fracture reduction is the strongest predictor of clinical outcome in acetabular fixation surgery. Materials and Methods: Twenty-four patients with posteriorly based acetabular fracture were treated with open reduction and internal fixation using Kocher- Langenbeck incision. In our series, there were 11 posterior wall, 3 posterior column, 5 transverse, 2 posterior column and posterior wall and 3 transverse and posterior wall fractures. All the patients were in the age group of 30 to 45 years (mean age 38.5 years). Males dominated our series (n=18 i.e. 75%) and right side was more commonly involved in both the sexes (n=14 i.e. 58.33%). Road traffic accident was the leading cause (n=19 i.e. 79.16%). All the patients were operated achieving adequate stability and with utmost soft tissue care. Follow up radiograph were graded according to criteria developed by Matta J et al. A minimum follow up was two years. Result: Patient with accurate reconstruction (n =21 i.e. 87.50%) had good or excellent functional outcome while two patients (08.33%) with inaccurate reduction and one patient (04.16%) with poor reduction had fair and poor outcome respectively. Conclusion: Despite relatively large number of possible complications Kocher–Langenbeck Approach is the best suited approach for posterior acetabular fracture.   Keywords: Kocher -langenbeck approalar, Acetabular fracture, Open reduction and internal fixation.

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Abstract

Background: Delayed presentation of fracture neck of femur is not uncommon in our scenario and is difficult to treat because of precarious vascularity and bony defect at fracture site. Aims: The purpose of the present study is the analysis of functional outcome of the muscle pedicle bone graft porcedure in ununited fracture neck of femur in children and adolescents. Materials and Methods: Sixteen patients with ununited fracture neck of femur (presenting late) in children and adolescents were treated with quadratus femoris based muscle pedicle bone graft along with open reduction and internal fixation. Mean age of the patient was 14.25 year (range 12-16 years). Boys dominated our series (n= 10 i.e.62.50%). Road traffic accident was the leading cause. Average injury –surgery interval was 5.88 week (range 3-9 week). A minimum follow up was two years. There were 2 Transepiphyseal, 11 Transcervical and 3 Cervicotrochanteric fractures. Result: Most of the cases showed union in 16 to 24 weeks. In one case there was implant failure. Analysis: The result was analysed using Harris Hip Score. We had 11 (68.75%) excellent, 2 (12.50%) Good, 2(12.50%) Fair and one (06.25%) Poor results in our series. Quadratus femoris based Muscle pedicle bone with internal fixation is a very effective method to address the difficult problem of non-union fracture neck of femur. There was statistically significant association (p value

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