Surgical Hip Dislocation for Exposure of the Posterior Column.

Siebenrock, Klaus-Arno; Keel, Marius; Tannast, Moritz; Bastian, Johannes (2019). Surgical Hip Dislocation for Exposure of the Posterior Column. JBJS essential surgical techniques, 9(1), e2. Lippincott Williams and Wilkins 10.2106/JBJS.ST.18.00048

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Background Surgical hip dislocation is performed for safe and efficient management of acetabular fractures predominantly involving the posterior column. The dislocation of the femoral head allows for direct visualization of the hip joint during fracture treatment. Description The patient is placed in the lateral decubitus position with sterile preparation and draping of the ipsilateral leg to allow for dislocation. The skin incision is straight and centered over the greater trochanter. After the skin incision, the interval between the gluteus maximus and medius muscles is developed. The sciatic nerve is identified, and special attention to the course of the medial circumflex femoral artery is given during dissection of the piriformis and triceps coxae muscles (obturator internus and superior and inferior gemelli muscles). The latter are incised 2 cm posterior to their insertion on the posterior aspect of the greater trochanter. The vastus lateralis muscle belly is elevated from the lateral femoral shaft, and a trochanteric osteotomy is performed. The trochanteric medallion is rotated 90°, and the gluteus minimus muscle is released from the capsule. After complete exposure of the hip capsule, a z-shaped capsulotomy is performed whereby any injury to the posterior capsular attachments of a posterior wall fragment is avoided. The posterior column and the greater and lesser sciatic notches are exposed, with the sciatic nerve under protection. The femoral head is dislocated either anteriorly or posteriorly to obtain direct visualization of the hip. Reduction begins at the articular surface, in cases of marginal impaction, and proceeds to the posterior wall and/or posterior column and the anterior column, when involved. For fixation, 3.5-mm cortical screws acting as positioning or lag screws and reconstruction plates are used. The capsule is sutured, the trochanteric fragment is reduced anatomically and stabilized with two 3.5-mm cortical screws, the piriformis and triceps coxae muscles are sutured, and a layered closure is performed. Alternatives The Kocher-Langenbeck approach might be used instead. Rationale Surgical hip dislocation facilitates assessment of cartilage damage at the acetabulum, marginal impaction, labral tears and femoral head lesions, removal or reinsertion of free intra-articular fracture fragments, direct visualization of the accuracy of reduction, and verification of extra-articular screw placement.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Siebenrock, Klaus-Arno; Keel, Marius; Tannast, Moritz and Bastian, Johannes Dominik

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2160-2204

Publisher:

Lippincott Williams and Wilkins

Language:

English

Submitter:

Kathrin Aeschlimann

Date Deposited:

31 Oct 2019 08:31

Last Modified:

31 Oct 2019 08:37

Publisher DOI:

10.2106/JBJS.ST.18.00048

PubMed ID:

31086720

BORIS DOI:

10.7892/boris.134152

URI:

https://boris.unibe.ch/id/eprint/134152

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