Master the treatment of posterior acetabular wall fractures associated with hip dislocation. This training offers a technical immersion in a carefully planned and executed surgical approach, aiming for fragment reduction, fixation to re-establish joint congruence, and hip stability.

Training Focus:

• Surgical treatment of posterior acetabular wall fractures with hip dislocation.
• Kocher-Langenbeck surgical approach.
• Reduction and fixation of fragments to restore joint anatomy and function.
• Protection of neurovascular structures, with emphasis on the sciatic nerve and circumflex artery.
• Reconstruction of external rotator muscles.

Detailed Content:

• Initial Assessment and Optimized Surgical Access: Learn to interpret CT scans to identify hip dislocation and large posterior acetabular wall fragments. Master the Kocher-Langenbeck approach, using landmarks such as the apex of the greater trochanter, the posterior superior iliac spine, and the long axis of the femur.
• Strategic Dissection and Exposure: Develop the skill of performing an incision in the iliotibial tract and blunt dissection through the gluteus maximus fibers. Identify and elevate the gluteus medius, and perform tenotomy of the gluteus maximus to facilitate exposure. Identify the external rotators, including the piriformis, superior gemellus, obturator internus, and inferior gemellus.
• Neurovascular Protection and Safe Tenotomy: Execute piriformis tenotomy and identify the superior and inferior gemellus muscles, and the obturator internus. Understand the crucial protection of the quadratus femoris, due to the passage of the circumflex artery that nourishes the femoral head in this region. Use the retracted tendons (piriformis and gemelli) as padding for the sciatic nerve, which passes adjacent to the access.
• Precise Fragment Identification and Reduction: Learn how to identify the inferior and superior fragments of the acetabular roof. Learn to clean and free the joint for better identification of reduction parameters, and reposition the fragments in their anatomical locations after dislocation reduction.
• Provisional Fixation and Plate Contouring: Master the technique of introducing the inferior retractor into the lesser sciatic notch after careful detachment. Perform provisional fixation of fragments with Kirschner wires. Use aluminum to contour a plate model, which will be used for the definitive fixation plate.
• Definitive Fixation with Multiple Plates: Learn to fix the main plate to the ischium, contouring the entire posterior rim, with screws directed towards the acetabular roof. Use a second plate at the apex of the superior fragment for fixation. Understand how the use of these two plates provides satisfactory reduction and stability, eliminating the need for spring plates.
• Anatomical Reconstruction and Closure: Perform identification and reconstruction of the piriformis, superior gemellus, inferior gemellus, and obturator internus tendons. Learn to reinsert the piriformis in its original position, with slight external rotation of the hip assisting in tendon reinsertion. Restore the anatomical structure with preservation of the quadratus femoris and gluteus medius, without muscle cuts. Finalize with suture of the iliotibial tract.

Included Material:

• Detailed Technical PDF: Didactic document describing the surgical procedure for treating posterior acetabular wall fractures associated with hip dislocation, from initial evaluation to reconstruction and closure.

Enhance your hip surgery skills. Enroll now and master advanced techniques for acetabular reconstruction, ensuring restoration of joint congruence and hip stability for your patients.