Kocher-Langenbeck Approach in Prone Position

The posterior approach for acetabular fractures is the Kocher-Langenbeck (K-L) approach which is performed in lateral and prone positions. Lateral position is a familiar position for most orthopedic surgeons. Prone position yields multiple advantages compared to lateral position.

Between the years 2016 and 2019, 18 patients with selected acetabular fractures in which the best decision was surgical fixation using K-L approach were studied. The surgical procedure was done using K-L approach with the patient in the prone position and we used Matta scoring system to evaluate post-operative reduction quality.

According to the Matta system, the anatomic reduction was observed in 13 patients (86.6%). Imperfect reduction was observed in 2 patients (13.3%), no patient had a poor reduction. Avascular necrosis (AVN) of the femoral head was seen in one patient (6.6%) and no infection and heterotopic ossification (HO) was noted.

The advantage of this approach in a prone position is believed to be better exposure and greater access to the quadrilateral plate (QLP) and anterior column indirectly. One of the most important advantages is that in the prone position, handling the reduction devices to indirectly reduce anterior column or QLP is much easier.