ACETABULUM [CASE 02] · Posterior Rim + Articular Impaction
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description: 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 less…
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