Posterior Approach

The posterior, or Kocher-Langenbeck, approach is familiar to most orthopedic surgeons from arthroplasty experience, but this can often lead to a false sense of confidence in that the technique is different when attempting to reduce and stabilize a fracture. The general indications for this approach are posterior wall and posterior column fractures and T-type and both-column fractures, which require direct posterior exposure. Visualization from the greater sciatic notch to the ischial tuberosity including the lateral aspect of the posterior column and posterior wall is usually achieved, and while palpation of the superior lateral dome is possible, visualization past the 12 o'clock position necessitates some type of trochanteric osteotomy. Fundamental to current technique is an emphasis on minimizing subperiostial and external rotator dissection and gluteal muscle damage in an attempt to avoid heterotopic ossification.

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