ACETABULUM [CASE 02] · Posterior Rim + Articular Impaction
The presence of osteochondral impaction associated with a posterior wall acetabular fracture imposes a mandatory technical sequence: without prior disimpaction, anatomical reduction of the wall fragment cannot be completed. This training presents the complete management of a hip fracture-dislocation with a multifragmentary posterior wall fracture and associated impaction, using the Kocher-Langenbeck approach, protective repair of the external rotators, articular disimpaction guided by tomographic correlation, and fixation with spring plates and a contoured posterior column plate, demonstrated in 4K video from the surgical perspective. TRAINING FOCUS Correlation between three-dimensional tomographic reconstruction and fracture pattern. Kocher-Langenbeck approach and anatomical landmarks in a patient with increased muscle mass. Tenotomy and protective repair of the external rotators. Retractor anchoring in the greater and lesser sciatic notches. Osteochondral disimpaction and restoration of the articular surface. Reduction sequence: impaction before posterior wall. Provisional fixation with Kirschner wires. Positioning and contouring of spring plates for multifragmentary fragments. Posterior column fixation with a plate contoured from the acetabular roof to the ischium. Transosseous reinsertion of the external rotators. DETAILED CONTENT Applied Tomographic Reading: Direct correlation between the 3D reconstruction and intraoperative findings for identification of fragments, the posterior column fracture line, and the impaction area. Kocher-Langenbeck Approach in a Difficult Field: Anatomical landmarks and adaptation of exposure in a young patient with increased muscle volume. Vascular and Neural Protection: Preservation of the quadratus femoris and the circumflex artery, identification of the sciatic nerve course, and use of the repaired rotators as a protective barrier. Safe Retractor Anchoring: Positioning technique guided by digital palpation in the greater and lesser sciatic notches. Osteochondral Disimpaction: Elevation of the fragment with an adequate volume of cancellous bone for stable support without the need for grafting. Impaction-Wall Reduction Sequence: Two-stage reduction logic, with the femoral head functioning as a mold for the anatomical fit of the fragment. Fixation with Spring Plates: Positioning criteria, staggered screw tightening, and directioning that avoids articular penetration. Contouring and Fixation of the Posterior Column: Plate-bending technique during screw tightening and fixation from the acetabular roof to the ischium. Repair and Reinsertion of the External Rotators: Transosseous technique with holes in the greater trochanter for direct tendon-to-bone contact. INCLUDED MATERIAL Detailed PDF: The PDF presents the tomographic analysis of the acetabular fracture-dislocation with associated impaction, the complete sequence of the Kocher-Langenbeck approach, the neurovascular protection criteria during exposure, the technical logic of disimpaction prior to posterior wall reduction, the fixation principles using spring plates and a contoured posterior column plate, and the transosseous reinsertion protocol for the external rotators. Master the reduction sequence in acetabular fractures with associated impaction. Enroll now and apply this technical logic in your next surgery.