Which structure is MOST at risk during the Kocher-Langenbeck (KL) surgical approach for posterior acetabular fracture fixation?

• A Femoral nerve and femoral artery
• B Lateral femoral cutaneous nerve and superior gluteal nerve
• C Obturator nerve and corona mortis anastomosis
• D Sciatic nerve and the terminal branch of the medial femoral circumflex artery (superior retinacular artery) ✓

Explanation

The Kocher-Langenbeck (posterolateral) approach for posterior column and posterior wall acetabular fractures poses greatest risk to the sciatic nerve (which lies posterior to the hip joint and posterior column, traversing the operative field) and the medial femoral circumflex artery's superior retinacular branch (which supplies the femoral head via the posterior neck). Excessive traction on the sciatic nerve can cause foot drop. Disruption of the MFCA retinacular branch risks avascular necrosis of the femoral head. Obturator nerve and corona mortis are at risk in ilioinguinal/Stoppa approaches. The lateral femoral cutaneous nerve is at risk in the ilioinguinal approach.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.