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Wang Z, Kenmegne GR, Zeng J, Chen M. Clinical analysis of Ganz approach in the treatment of Pipkin type IV fracture: a retrospective review. BMC Musculoskelet Disord 2025; 26:343. [PMID: 40200319 PMCID: PMC11980066 DOI: 10.1186/s12891-025-08583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/25/2025] [Indexed: 04/10/2025] Open
Abstract
PURPOSE This study aimed to evaluate the early clinical outcomes of the Ganz approach in treating Pipkin IV fractures. METHODS From January 2016 to January 2021, 22 patients with Pipkin IV fracture were treated in our department with Ganz approach. The operation time, intraoperative blood loss, fracture healing time, the incidence of postoperative complications such as heterotopic ossification of hip joint and avascular necrosis of femoral head were recorded. Radiological assessment of fracture reduction was achieved using Matta's evaluation criteria. The functional recovery of the hip joint was assessed using the Harris Hip Score at one year and before the current study, as well as the modified Merle d'Aubigné and Postel score during the final evaluation. RESULTS 21 patients were available for follow up. The average intraoperative blood loss was 145.5 ± 39.3 ml and the average operation time was 150.4 ± 40.6 min. The average follow-up time was 39.2 ± 11.2 months. X-ray confirmed bony healing of the femoral head, acetabular fractures, and greater trochanter osteotomy, with an average healing time of 7.22 ± 3 months. The difference between the Harris hip score of hip joint at one year and at the last follow-up was not statistically significant (p = 0.06). At final follow up with the modified Merle D'Aubigne Postel score, nine had excellent functional outcome; ten presented very good to good result while two patients had average (one) to poor (one) result. Two (9.5%) patient developed osteonecrosis (avascular necrosis) of the femoral head. CONCLUSION The Ganz approach effectively preserves the blood supply to the femoral head, moreover, it also fully expose the operative fields such as hip joint and femoral head, achieving satisfactory clinical outcomes, making it a valuable option for clinical application.
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Affiliation(s)
- Zhiwen Wang
- Department of Orthopaedic Surgery, Trauma Center, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Guy Romeo Kenmegne
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma Center, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jingjun Zeng
- Department of Orthopaedic Surgery, Trauma Center, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Ming Chen
- Department of Orthopaedic Surgery, Trauma Center, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
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Giannoudis PV, Gonzalez Edery E, Nemade P, Bagaria V. Femoral head impaction fracture: a new technique for closed reduction and biological stabilisation. BMJ Case Rep 2025; 18:e264269. [PMID: 40164476 PMCID: PMC11962589 DOI: 10.1136/bcr-2024-264269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 03/20/2025] [Indexed: 04/02/2025] Open
Abstract
Impaction femoral head fractures are seldom diagnosed or treated, even though they can be present in between 39% and 57% of acetabular-fracture dislocations or hip dislocations. These fractures can cause residual hip pain, instability, avascular necrosis (AVN) and early joint wear, potentially necessitating a total hip arthroplasty. Treatment options range from expectant management, which carries a high risk of AVN, to controlled hip dislocation and mosaicplasty, the latter demonstrating variable results.We present the case of a woman in her 50s with an impaction femoral head fracture treated via closed reduction with a bent rod using a predrilled tunnel created with the dynamic hip screw reamer, followed by biological stabilisation with allografts, bone morphogenetic protein-2 and stem cells to provide the appropriate environment for bone healing. This minimally invasive technique offers a viable treatment option for impaction femoral head fractures, with low morbidity and favourable short and mid-term follow-up outcomes. Further studies can validate the results of this technique.
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Affiliation(s)
- Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, Univ Leeds, Leeds, UK
| | | | | | - Vaibhav Bagaria
- Trauma and Orthopaedics, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
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3
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Zamora T, Gehrung A, Klaber I, Carmona M, Schweitzer D, Botello E. Surgical dislocation of the hip without trochanteric osteotomy for the treatment of bone tumors around the hip. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:129. [PMID: 40116985 DOI: 10.1007/s00590-025-04258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 03/09/2025] [Indexed: 03/23/2025]
Abstract
PURPOSE Bone tumors around the hip pose significant surgical challenges. While surgical dislocation with a trochanteric flip osteotomy through a posterior approach is commonly used, it is associated with known complications. This study is the first to report outcomes using surgical hip dislocation without a trochanteric osteotomy for this purpose. We evaluated early to long-term outcomes of this approach and compared results between patients undergoing extensive curettage with adjuvants and those undergoing simple excision. METHODS Sixteen patients (18 hips) with benign or intermediate bone and synovial tumors were treated using surgical dislocation without a trochanteric flip osteotomy. Patients had a minimum follow-up of 12 months (median 3.6 years, range 1-11 years). Outcomes included local recurrence, complications, functionality, and quality of life (QoL) assessed with SF-12 (mental and physical components), HOOS, TESS, and MSTS scores. Comparative analysis was performed between extensive curettage with adjuvancy and simple excision. Results All procedures were completed successfully without any local recurrences or significant complications. Patients had a median hospital stay of 3 days (ranging from 1 to 4 days), and the median follow-up duration was 3.6 years (ranging from 1 to 13 years). The mean SF-12 physical and mental health scores were 51 and 42, respectively. Additionally, the scores for HOOS, MSTS, and TESS were 74, 77%, and 86%, respectively. One patient (6%) developed osteoarthritis, while three (17%) experienced lateral hip pain managed conservatively. No significant differences were found in complications, functionality, or QoL between the extensive curettage and simple excision groups. CONCLUSION Surgical dislocation of the hip without trochanteric osteotomy is a safe and effective alternative for excising tumors around the hip. It provides excellent exposure and achieves successful oncologic and functional outcomes. Patients requiring extensive curettage with adjuvants achieve comparable results to those treated with simple excision, offering a viable and novel surgical option for challenging cases.
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Affiliation(s)
- Tomas Zamora
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Antonia Gehrung
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ianiv Klaber
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maximiliano Carmona
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel Schweitzer
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Botello
- Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Schaffer NE, Luther L, Tatman LM, Mitchell PM. Femoral Head Fractures: Evaluation, Management, and Outcomes. J Am Acad Orthop Surg 2024; 32:929-937. [PMID: 38968607 DOI: 10.5435/jaaos-d-23-01121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/18/2024] [Indexed: 07/07/2024] Open
Abstract
Fractures of the femoral head typically occur after high-energy trauma. Radiographs and cross-sectional imaging are used to appropriately classify and identify associated injuries or morphologic characteristics that may influence management. Identification of the radiographic and clinical hallmarks of an irreducible variant is critical to optimizing the patient's outcome. Nonsurgical treatment can be used in the setting of small, infrafoveal femoral head fractures without hip instability. When surgical treatment is indicated, an anterior (Smith-Petersen), posterior (Kocher-Langenbeck), or surgical hip dislocation approach may be used depending on injury details and surgeon preference. The purpose of this review was to summarize current evidence on femoral head fractures regarding indications, variant patterns, surgical approaches, and outcomes.
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Affiliation(s)
- Nathaniel E Schaffer
- From the Western Washington Medical Group, Everett, WA (Schaffer), and the Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Luther, Tatman, and Mitchell)
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5
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Gänsslen A, Lindtner RA, Krappinger D, Franke J. Pipkin fractures: fracture type-specific management. Arch Orthop Trauma Surg 2024; 144:4601-4614. [PMID: 39349876 DOI: 10.1007/s00402-024-05576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 09/10/2024] [Indexed: 11/20/2024]
Abstract
Femoral head fractures are rare, which limits the experience of individual surgeons with these injuries. This overview examines historical data, injury mechanisms, and classification systems, as well as epidemiological data from larger patient cohorts. Significant controversies persist regarding the optimal surgical approach and fracture-type-specific treatment for Pipkin fractures. The literature is often inconsistent, as many studies fail to differentiate between specific fracture types and instead report aggregated results, leading to ambiguous conclusions about the most effective treatment strategies. Thus, this article reviews fracture-type-specific outcomes of both non-operative and operative treatments over the past 25 years and summarizes their clinical implications, with the aim of assisting surgeons in their decision-making processes.
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Affiliation(s)
- Axel Gänsslen
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- University Hospital, Johannes Wesling Hospital, Hans-Nolte-Straße 1, 32429, Minden, Germany.
| | - Richard A Lindtner
- Department of Orthopaedic and Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Orthopaedic and Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Jochen Franke
- Trauma Department, Tauernkliniken, Paracelsusstraße 8, 5700, Zell, Austria
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Chen IJ, Chou YC, Lai PJ, Hsu YH, Yu YH. The modified Hardinge approach is not inferior to trochanteric flip osteotomy for Pipkin type IV femoral head fractures: a comparative study in 40 patients. Eur J Trauma Emerg Surg 2024; 50:1859-1867. [PMID: 38748242 PMCID: PMC11458743 DOI: 10.1007/s00068-024-02547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/03/2024] [Indexed: 10/08/2024]
Abstract
PURPOSE To compare the modified Hardinge approach and trochanteric flip osteotomy for the treatment of Pipkin type IV femoral head fractures. METHODS This retrospective study included 40 patients who underwent surgical treatment for Pipkin type IV femoral head fractures between 2011 and 2020 and completed at least 1 year of follow-up. The clinical outcome of the Merle d'Aubigné-Postel score and radiological outcomes, including the quality of the fracture reduction, osteonecrosis of the femoral head, posttraumatic osteoarthritis, and heterotopic ossification, were compared between the two groups. Conversion to total hip replacement was recorded as the main outcome measure, analyzed by Kaplan-Meier curve and log-rank test. RESULTS Nineteen and 21 patients were treated using the modified Hardinge approach (Group A) and trochanteric flip osteotomy (Group B), respectively. The estimated surgical blood loss was significantly higher in Group B (500.00 ± 315.44 mL vs. 246.32 ± 141.35 mL; P = 0.002). Two patients in Group B complained of discomfort caused by the trochanteric screws and requested implant removal. Radiographic outcomes did not differ significantly between the two groups. Clinical outcomes assessed using the Merle d'Aubigné-Postel score 1 year after injury were nearly identical (P = 0.836). Four (21.1%) patients in Group A and three (14.3%) patients in Group B underwent conversion to total hip replacement during the follow-up period; the log-rank test showed no significant difference (P = 0.796). CONCLUSIONS The modified Hardinge approach resulted in reduced blood loss, with clinical and radiological outcomes similar to those of trochanteric osteotomy; thus, it is an acceptable alternative to trochanteric flip osteotomy.
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Affiliation(s)
- I-Jung Chen
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - Ying-Chao Chou
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - Po-Ju Lai
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - Yung-Heng Hsu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan
| | - Yi-Hsun Yu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan.
- Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan.
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Kloub M, Látal P, Giannoudis P. Techniques and results of reconstruction of femoral head fractures: An Update. Injury 2024; 55:111473. [PMID: 38538488 DOI: 10.1016/j.injury.2024.111473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 05/24/2024]
Abstract
A narrative review of the literature was conducted to examine the data on femoral head fractures, with a particular focus on their management, complications and clinical outcomes. A PRISMA strategy was used. Medline and Scopus library databases were queried using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. The 50 eligible articles that met the predefined inclusion criteria reported on 1403 femoral head fractures. A detailed analysis of the surgical approaches used was performed in 38 articles with 856 fractures. Most fractures were treated surgically (90,8 %) with preferred anatomical reconstruction in 76,7 % of all operatively treated cases. Posterior approaches were the most common (52.5 %). This was evenly split between surgical hip dislocation and the classic Kocher-Langenbeck approach. 70.5 % of surgically treated cases achieved excellent or good result according to Thompson-Epstein criteria. Highest rate of excellent results showed minimal invasive osteosynthesis and surgical hip dislocation. Major late complications were avascular necrosis (10.8 %), post-traumatic arthritis (16.2 %) and heterotopic ossification (20.8 %). Secondary THA was necessary in 6.9 %. Highest rate of major complications was joined with anterior approach (77 %), lowest rate from frequently used approaches surgical hip dislocation (37.8 %). Conservative treatment recedes into the background. The Ganz flip osteotomy with surgical hip dislocation allows safe treatment of all types of fractures and should be considered the first choice, offering the lowest rate of complications and one of the best functional outcomes. Reconstruction of Pipkin Type III fractures should be reserved for very young patients due to high rate of major complications.
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Affiliation(s)
- Martin Kloub
- Department of Traumatology Hospital České Budějovice, Czech Republic.
| | - Pavel Látal
- Department of Traumatology Hospital České Budějovice, Czech Republic
| | - Peter Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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8
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Influence of associated femoral head fractures on surgical outcomes following osteosynthesis in posterior wall acetabular fractures. BMC Musculoskelet Disord 2022; 23:830. [PMID: 36050675 PMCID: PMC9434972 DOI: 10.1186/s12891-022-05777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background To date, no study has compared the surgical outcomes between posterior wall acetabular fractures with and without associated femoral head fractures. Therefore, we evaluated whether an associated femoral head fracture increases the incidence of fracture sequelae, including post-traumatic osteoarthritis (PTOA) and osteonecrosis of the femoral head (ONFH), following osteosynthesis for posterior wall acetabular fractures. Methods This retrospective clinical study enrolled 183 patients who underwent osteosynthesis for posterior wall acetabular fractures between 2009 and 2019 at a level-1 trauma center. The incidence of PTOA, ONFH, and conversion to total hip arthroplasty (THA) was reviewed. Results The incidence of PTOA, ONFH, and conversion to THA following osteosynthesis were 20.2%, 15.9%, and 17.5%, respectively. The average time for conversion to THA was 18.76 ± 20.15 months (range, 1–82). The results for the comparison of patients with associated femoral head fractures and isolated posterior wall acetabular fractures were insignificant (PTOA: 27.3% vs. 15.7%, p = 0.13; ONFH: 18.2% vs. 14.3%, p = 0.58; conversion to THA: 20.4% vs. 15.7%, p = 0.52). Upon evaluating other variables, only marginal impaction negatively affected ONFH incidence (odds ratio: 2.90). Conclusions Our methods failed to demonstrate a significant difference in the rate of PTOA, ONFH, or conversion to THA in posterior wall acetabular fractures with and without an associated femoral head fracture. Beyond femoral head fractures, the marginal impaction of the acetabulum could have led to early sequelae. Level of evidence Level III
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9
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Martin MP, Cole MW, Patel AH, Sherman WF. Gunshot Wound to the Hip Resulting in a Femoral Head and Acetabulum Fracture Treated With Open Reduction and Internal Fixation and Bipolar Hemiarthroplasty. Arthroplast Today 2022; 16:229-236. [PMID: 35880228 PMCID: PMC9307496 DOI: 10.1016/j.artd.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 11/05/2022] Open
Abstract
Combined fractures of the femoral head and acetabulum due to ballistic injuries are rare injuries, especially in the elderly. We present a case of a 70-year-old female who sustained a gunshot wound to the left hip, resulting in a comminuted femoral head fracture and posterior wall acetabular fracture. She was treated with open reduction and internal fixation of the acetabulum, as well as bipolar hemiarthroplasty for treatment of her femoral head fracture. At her 18-month follow-up visit, the patient was doing well and had no complaints.
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Rojas-Sayol R, De Caso J, Valera M. Arthroscopic-Assisted Percutaneous Fixation of a Femoral Head Fracture (Pipkin II): A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00027. [PMID: 36040067 DOI: 10.2106/jbjs.cc.22.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE Fractures of the femoral head are infrequent injuries with potentially devastating complications. Pipkin type II fractures often require surgical fixation. It involves intraarticular approaches that may increase the inherent morbidity of these fractures. Hip arthroscopy minimizes surgical aggression and allows for direct control of fracture reduction. We present a case report of an arthroscopic-assisted percutaneous fixation of a Pipkin-II femoral head fracture. A hip arthroscopy without traction and percutaneous screw fixation was conducted under arthroscopic and fluoroscopic guidance. CONCLUSION Arthroscopic-assisted percutaneous fixation is a useful technique for optimal femoral head fracture treatment and may also minimize surgical morbidity and optimize early recovery.
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Affiliation(s)
- Roger Rojas-Sayol
- Orthopedic Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - J De Caso
- Trauma Orthopaedic Surgery Unit, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Valera
- Hip Orthopaedic Surgery Unit, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lian S, Yang Z, Hu Z, Mu W. A combination of the K-L and S-P approaches for treating acetabular posterior wall factures accompanied by femoral head fractures with open reduction and internal fixation. BMC Surg 2022; 22:165. [PMID: 35538455 PMCID: PMC9092786 DOI: 10.1186/s12893-022-01597-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background In clinical practice, acetabular posterior wall fracture combined with femoral head fracture is rare. However, with the increasing number of engineering and traffic accidents, such fractures, have increased significantly in recent years. This paper aims to explore the clinical efficiency of the Kocher-Langenbeck (K-L) and Smith-Petersen (S-P) combined approaches for open reduction and internal fixation (ORIF) of acetabular posterior wall fractures accompanied by femoral head fractures (Pipkin type IV fractures). Methods A retrospective study was conducted on 8 patients who underwent open reduction and internal fixation (ORIF) of Pipkin type IV fractures through the K-L combined with S-P approach in our hospital from January 2015 to January 2020. All 8 patients were successfully operated on without serious complications, such as important blood vessel and nerve damage, with an operation time of 143.8 ± 44.38 min and intraoperative blood loss of 225 ± 70.71 ml. Perioperative data were recorded. The Harris score was used to evaluate the clinical effect. Fracture reduction quality was evaluated according to the Matta radiological standard. The grade of ectopic ossification was evaluated by the Brooker grading method, and the stage of femoral head necrosis was evaluated by Ficat-Arlet staging. Results The Harris score increased significantly from 57.38 ± 4.779 at 3 months, to 76.13 ± 3.682 at 6 months, 88.25 ± 3.495 at 12 months, and 92.13 ± 2.232 at 36 months postoperatively. After statistical analysis, compared with the previous observation time point, the data comparison differences between the groups were statistically significant. P < 0.001, P < 0.001, P < 0.05). By the time of the latest follow-up, 6 of the 8 patients had recovered to the level of pre-injury sports capacity. In contrast, the other 2 patients remained below the level of pre-injury sports capacity. In terms of imaging evaluation, the quality of fracture reduction on radiographs was graded as excellent in 6 patients and good in 2 patients according to Matta’s criteria. At the last follow-up, no heterotopic ossification or femoral head necrosis was found in of all the images. In addition, the hip joint space was normal in 6 cases, mildly narrowed in 1 case, and clearly narrowed in 1 case. Conclusions The K-L combined with S-P approach provides effective exposure for the reduction and fixation of Pipkin type IV fractures and achieves satisfactory clinical outcomes. Supplementary information The online version contains supplementary material available at 10.1186/s12893-022-01597-w.
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Affiliation(s)
- Shichao Lian
- Department of Traumatic Orthopedics, Shandong Provincial Hospital, Shandong University, No. 324 Jingwu Weiqi Road, Jinan, 250012, Shandong, China.,Zoucheng People's Hospital, No. 59 Qianquan Road, Zoucheng, 273500, Shandong, China
| | - Zhong Yang
- Binzhou Medical University, No. 346 Guanhai Road, Yantai, 264003, Shandong, China
| | - Zongliang Hu
- Department of Traumatic Orthopedics, Shandong Provincial Hospital, Shandong University, No. 324 Jingwu Weiqi Road, Jinan, 250012, Shandong, China
| | - Weidong Mu
- Department of Traumatic Orthopedics, Shandong Provincial Hospital, Shandong University, No. 324 Jingwu Weiqi Road, Jinan, 250012, Shandong, China.
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12
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Management of femoral head fracture by Ganz surgical dislocation of the hip. J Orthop Traumatol 2022; 23:24. [PMID: 35538323 PMCID: PMC9091069 DOI: 10.1186/s10195-022-00643-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/16/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture. PATIENTS AND METHODS In this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta's criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d'Aubigne and Postel score at final follow-up. RESULTS No patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta's criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d'Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results. CONCLUSION Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate.
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Khalifa AA, Refai O, Farouk O, Abdelnasser MK. Management of femoral head fractures through surgical hip dislocation (SHD): a demanding but safe technique. Arch Orthop Trauma Surg 2021; 141:1701-1710. [PMID: 33113013 DOI: 10.1007/s00402-020-03666-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Femoral head fractures considered to be rare injuries. Surgical intervention is indicated for major fragment displacement or in the presence of instability. Surgical management can be achieved through either Anterior, posterior, and trans-trochanteric surgical approaches. Surgical hip dislocation (SHD) has been advocated by many authors to be a safe and effective alternative way of management. The aim of this study was to report on the accuracy of fracture reduction, procedure safety, and outcomes of using SHD in the management of femoral head fractures. PATIENTS AND METHODS Between 2011 and 2017, 31 patients presented with femoral head fracture were treated through SHD. At a mean follow-up of 48 months, 27 patients were available for the study with a mean age of 33.8 years. Patient demographics, clinical evaluation according to modified Harris hip score and modified Merle d'Aubigne and Postel score, radiographic fracture reduction according to Matta's criteria, and any complications were reported. RESULTS Excellent and good clinical outcomes were reported in 25 (92.6%) and 24 (89%) patients according to the modified Harris hip and modified Merle d'Aubigne and Postel scores, respectively. Anatomic fracture reduction was achieved in 21 (77.8%) patients. Two (7.4%) patients developed AVN, one (3.6%) patient developed hip OA (grade 3 according to Tönnis classification), and five (18.5%) patients developed asymptomatic Brooker stage I heterotopic ossification. No infection or trochanteric flip osteotomy fragment non-union was reported. CONCLUSIONS SHD offers a safe and efficient approach for femoral head fractures management with acceptable clinical outcomes as well as complication rates. Giving the advantage of fully exposing the femoral head and the acetabulum which enables the surgeon to anatomically reduce the fracture and treat any associated injuries, SHD is recommended besides other approaches for the management of femoral head fractures.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt.
- Orthopaedic and Traumatology Department, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga highway, Qena, 83523, Egypt.
| | - Omar Refai
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
| | - Osama Farouk
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
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Khalifa AA, Haridy MA, Fergany A. Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis. World J Orthop 2021; 12:604-619. [PMID: 34485106 PMCID: PMC8384609 DOI: 10.5312/wjo.v12.i8.604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/20/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Femoral head fractures (FHFs) are considered relatively uncommon injuries; however, open reduction and internal fixation is preferred for most displaced fractures. Several surgical approaches had been utilized with controversial results; surgical hip dislocation (SHD) is among these approaches, with the reputation of being demanding and leading to higher complication rates. AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature. METHODS Major databases including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs. We extracted basic studies data, surgery-related data, functional outcomes, radiological outcomes, and postoperative complications. We calculated the mean differences for continuous data with 95% confidence intervals for each outcome and the odds ratio with 95% confidence intervals for binary outcomes. P < 0.05 was considered significant. RESULTS Our search retrieved nine studies meeting our inclusion criteria, with a total of 129 FHFs. The results of our analysis revealed that the average operation time was 123.74 min, while the average blood loss was 491.89 mL. After an average follow-up of 38.4 mo, a satisfactory clinical outcome was achieved in 85% of patients, with 74% obtained anatomical fracture reduction. Overall complication rate ranged from 30% to 86%, with avascular necrosis, heterotopic ossification, and osteoarthritis being the most common complications occurring at an incidence of 12%, 25%, and 16%, respectively. Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4% and 3.8%, respectively. CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis, the formation of heterotopic ossification, and the development of posttraumatic osteoarthritis; however, it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.
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Affiliation(s)
- Ahmed A Khalifa
- Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qena 83523, Qina, Egypt
| | - Mohamed A Haridy
- Department of Orthopaedic, Ibri Regional Hospital, Ibri 511, Oman
| | - Ali Fergany
- Department of Orthopaedic, Assiut University Hospital, Assiut 71515, Egypt
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Coulomb R, Alrubaie A, Haignière V, Kouyoumdjian P. Femoral head mosaicplasty by direct anterior approach for an osteochondral impaction without performing surgical hip dislocation. SICOT J 2021; 7:22. [PMID: 33812469 PMCID: PMC8019562 DOI: 10.1051/sicotj/2021014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/21/2021] [Indexed: 11/16/2022] Open
Abstract
Several surgical methods exist for the treatment of osteochondral lesions of the femoral head. They include osteochondral allograft transfer, femoral osteotomy, microfracture, autologous chondrocyte implantation, and hip arthroplasty. Mosaicplasty is a surgical method in which cylindrical plugs of bone and cartilage are transferred from a donor site to tunnels drilled into the bone and cartilage defects. This paper discusses the use of mosaicplasty by a direct anterior approach without dislocation in the treatment of an acute femoral head osteochondral impaction in a young patient.
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Affiliation(s)
- Remy Coulomb
- Department of Orthopedic and Traumatology Surgery, CHU Nîmes, University Montpellier 1, 34000 Nîmes, France
| | - Abdullah Alrubaie
- Department of Orthopedic and Traumatology Surgery, CHU Nîmes, University Montpellier 1, 34000 Nîmes, France
| | - Vincent Haignière
- Department of Orthopedic and Traumatology Surgery, CHU Nîmes, University Montpellier 1, 34000 Nîmes, France
| | - Pascal Kouyoumdjian
- Department of Orthopedic and Traumatology Surgery, CHU Nîmes, University Montpellier 1, 34000 Nîmes, France - Université Montpellier 1, 2 Rue de l'École de Médecine, 34090 Montpellier, France
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Liu Y, Dai J, Wang XD, Guo ZX, Zhu LQ, Zhen YF. Open reduction and Herbert screw fixation of Pipkin type IV femoral head fracture in an adolescent: A case report. World J Clin Cases 2021; 9:898-903. [PMID: 33585637 PMCID: PMC7852633 DOI: 10.12998/wjcc.v9.i4.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Femoral head fracture is extremely rare in children. This may be the youngest patient with femoral head fracture ever reported in the literature. There are few pediatric studies that focus on cases treated with open reduction via the modified Hardinge approach.
CASE SUMMARY A 14-year-old female adolescent suffered a serious traffic accident when she was sitting on the back seat of a motorcycle. A pelvic radiograph and computed tomography revealed a proximal femoral fracture and slight acetabular rim fracture. This was diagnosed as a Pipkin type IV femoral head fracture. An open reduction and Herbert screw fixation was performed via a modified Hardinge approach. After 1-year follow-up, the patient could walk without aid and participate in physical activities. The X-ray results showed that the fractures healed well with no evidence of complications.
CONCLUSION Open reduction and Herbert screw fixation is an available therapy to treat Pipkin type IV femoral head fractures in children.
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Affiliation(s)
- Yao Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Jin Dai
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Xiao-Dong Wang
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Zhi-Xiong Guo
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Lun-Qing Zhu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Yun-Fang Zhen
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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Liu B, Wu Z, Zhuang Z, Liu S, Li H, Han Y. Diagnosis, preoperative evaluation, classification and total hip arthroplasty in patients with long-term unreduced hip joint dislocation, secondary osteoarthritis and pseudoarthrosis. BMC Musculoskelet Disord 2020; 21:661. [PMID: 33032581 PMCID: PMC7545563 DOI: 10.1186/s12891-020-03678-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Neglected long-term unreduced hip joint dislocation with secondary osteoarthritis and pseudoarthrosis poses a great challenge to hip surgeons. However, as this is an uncommon injury, few studies have systematically investigated these patients. METHODS We retrospectively reviewed 16 patients from 2010 to 2017. The diagnostic values of three different types of common radiological examinations were evaluated. We evaluated the bone conditions of the original acetabulum and classified the patients into three types (four subtypes). The surgical procedures and prognosis of the patients were also investigated. RESULTS With the combined application of X-ray, CT scans and 3D reconstruction, 93.8% of these patients (sensitivity = 93.8%, Youden's index = 0.93, intraclass correlation coefficient = 0.95) could be diagnosed correctly. There were 6/16 (37.5%) type A patients, 4/16 (25.0%) type B1 patients, 5/16 (31.3%) type B2 patients and 1/16 (6.3%) type C patient. For patients with type A injury, the surgical procedures for total hip arthroplasty were similar to "standard" total hip arthroplasty. For patients with type B injury, due to atrophy or partial bone deficiency of the original acetabulum, the surgical procedure for total hip arthroplasty was probably similar to those for patients with developmental dysplasia of the hip. For patients with type C injury, the situation was similar to that of revision surgery. The average Harris hip score postoperatively was 89.94 ± 5.78 points (range: 79-98 points). CONCLUSIONS The new classification system could help surgeons estimate potential difficulties during total hip arthroplasty. The prognosis of most patients after total hip arthroplasty is expected to be excellent or good.
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Affiliation(s)
- Bo Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Zhaoke Wu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
- Department of Orthopedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, Fujian P.R. China
| | - Zhikun Zhuang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
- Department of Orthopedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, Fujian P.R. China
| | - Sikai Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Huijie Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province P.R. China
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Peng SH, Wu CC, Yu YH, Lee PC, Chou YC, Yeh WL. Surgical treatment of femoral head fractures. Biomed J 2020; 43:451-457. [PMID: 33011107 PMCID: PMC7680813 DOI: 10.1016/j.bj.2019.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/31/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Femoral head fractures (FHF) are uncommon and generally caused by high-energy injuries. Surgical reduction with stable fixation of large fragments is believed to have the best outcomes. This retrospective study intended to report outcomes with surgical treatment at our institution and tried to establish treatment algorithm. Methods Through the 6-year period (2003–2008), 35 FHF in 35 consecutive patients (average, 30 years) were surgically treated. All FHF were caused by high-energy trauma. Patients' general condition was stabilized first and hip dislocation was manually reduced immediately. Definite fracture treatment was scheduled after admission for an average of 2.9 days (0.3–11 days). Pipkin classification was used as the treatment guide and open reduction with internal fixation was performed in all 35 FHF. Results These FHF included 21 type I, 7 type II, 3 type III, and 4 type IV fractures. The hip joint had been approached by either an anterior or posterior route depending on the individual surgeon. Internal fixation with screws was performed for all 35 FHF. The average admission was 13.8 days (range, 2–35 days). Thirty patients (86%, 30/35) were followed for an average of 3.3 years (at lease 6 months) and all 30 FHF healed. Avascular necrosis of the femoral head was found in 23% (7/30) patients and six patients were converted to hip arthroplasty for developing advanced stages of avascular necrosis. Heterotopic ossification occurred in 43% (13/30) patients. However, only one patient had range of motion limitation. Besides, one patient had moderate hip osteoarthritis. Conclusions FHF are uncommon and generally caused by high-energy injuries. Fracture healing can be attained in all femoral head fractures by using open reduction and screw fixation. Our results by using conventional approaches were associated with high complication rates. Further endeavor to improve the outcome should be taken.
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Affiliation(s)
- Shih-Hui Peng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chuan Wu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Cheng Lee
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Lin Yeh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chen MJ, Wadhwa H, Tigchelaar SS, Frey CS, Gardner MJ, Bellino MJ. Trochanteric osteotomy for acetabular fracture fixation: a case series and literature review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:161-165. [PMID: 32743685 DOI: 10.1007/s00590-020-02753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/25/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study examined osteotomy union and heterotopic ossification (HO) after performing digastric trochanteric osteotomies during open reduction and internal fixation (ORIF) of acetabular and combined femoral head fractures. Femoral head osteonecrosis and trochanteric screw removal were secondarily assessed. METHODS Twenty-six patients treated at a Level I trauma center, from years 2003 to 2019, who received a digastric trochanteric osteotomy during acetabular and combined femoral head fracture ORIF through a posterior surgical approach were retrospectively identified. Osteotomies were fixed with two 3.5 mm cortical lag screws. Rates of osteotomy union, HO, femoral head osteonecrosis, and trochanteric screw removal were determined. RESULTS All osteotomies went onto union without displacement or failure of fixation. Only three (12%) patients developed severe HO (modified-Brooker class III-IV). There were no instances of femoral head osteonecrosis and only one (7%) patient required trochanteric screw removal. CONCLUSIONS The digastric trochanteric osteotomy heals reliably with low rates of severe HO, femoral head osteonecrosis, and screw removal for soft-tissue irritation. A review of the literature is presented and found comparable findings.
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Affiliation(s)
- Michael J Chen
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA.
| | - Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA
| | - Seth S Tigchelaar
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA
| | - Christopher S Frey
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA
| | - Michael J Bellino
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA, 94063-6342, USA
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Nolte PC, Franke J, Grützner PA, Keil H. [Reconstruction of a fracture of the posterior acetabular wall with Pipkin fracture and lesion of the sciatic nerve after dorsal hip dislocation]. Unfallchirurg 2020; 123:413-418. [PMID: 32060596 DOI: 10.1007/s00113-020-00783-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 50-year-old male suffered a crash landing while paragliding and sustained a posterior dislocation of the hip with a Pipkin fracture type 4 (fracture of the posterior acetabular wall and Pipkin fracture type 2) and a lesion of the sciatic nerve. After primary treatment in an external hospital, the patient was transferred to this hospital 4 days following the trauma. An operative stabilization of the acetabular fracture and the Pipkin fracture was performed using a trochanter flip osteotomy. Despite a large central defect of the femoral head it was decided to attempt a reconstruction. Following fixation of the Pipkin fragment an autologous bone graft harvested from the intertrochanteric region was used to fill the defect. Subsequently, a collagen matrix was applied onto the filled defect and a perineural adaptation of the sciatic nerve was performed.
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Affiliation(s)
- Philip-Christian Nolte
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Deutschland.
| | - Jochen Franke
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Paul Alfred Grützner
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Holger Keil
- Abteilung für Unfallchirurgie und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Deutschland
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León SA, Mei XY, Sanders EB, Safir OA, Gross AE, Kuzyk PRT. Does Trochanteric Osteotomy Length Affect the Amount of Proximal Trochanteric Migration During Revision Total Hip Arthroplasty? J Arthroplasty 2019; 34:2718-2723. [PMID: 31353250 DOI: 10.1016/j.arth.2019.06.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Nonunion and proximal trochanteric migration is a known complication of trochanteric osteotomy. This study examines the effect of osteotomy length on proximal greater trochanter (GT) migration. METHODS We analyzed 113 modified trochanteric slide osteotomies and 73 extended trochanteric osteotomies performed between 2008 and 2016. All osteotomies were fixed using cerclage wires and had minimum 6-month radiographic follow-up. Spearman correlations were used to assess association between osteotomy length and GT migration distance. Chi-squared test and logistic regression were used to assess association between patient and surgical factors and GT migration >1 cm. Receiver operating characteristic curves were constructed to determine the optimal cutoff osteotomy length for predicting GT migration >1cm. RESULTS Mean osteotomy length was 6.1 cm (range 3-12) for modified trochanteric slide osteotomies and 14.8 cm (range 8-23) for extended trochanteric osteotomies. Osteotomy length was negatively correlated (r = -0.340, P < .001) with GT migration distance. Longer osteotomy length was protective against GT migration >1 cm (odds ratio 0.67, P = .002). Receiver operating characteristic curve analysis demonstrated an optimal cutoff osteotomy length of 9.8 cm for predicting GT migration >1 cm (sensitivity 0.971, specificity 0.461). Among osteotomies <10 cm, those fixed using at least one distal wire below the lesser trochanter and vastus ridge demonstrated less mean GT migration (3.86 vs 7.12 mm, P = .009) and higher mean union rate (68.8% vs 31.2%, P < .001). CONCLUSION Osteotomies shorter than 10 cm are at higher risk of developing proximal GT migration >1 cm. A distal cerclage wire below the lesser trochanter and vastus ridge may help decrease the amount of GT migration. LEVEL OF EVIDENCE Prognostic Level IV.
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Affiliation(s)
- Sebastián A León
- Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xin Y Mei
- Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ethan B Sanders
- Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Oleg A Safir
- Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allan E Gross
- Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul R T Kuzyk
- Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Wang J, Cai L, Xie L, Chen H, Guo X, Yu K. 3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis. J Orthop Surg Res 2019; 14:338. [PMID: 31665055 PMCID: PMC6820951 DOI: 10.1186/s13018-019-1383-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Femoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity. PATIENTS AND METHODS Between 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d'Aubigne scores. The reduction of the fracture was evaluated according to Matta's criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented. RESULTS Twelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25-48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d' Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1). CONCLUSIONS The 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications. TRIAL REGISTRATION We register our research at http://www.researchregistry.com . The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847 .
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Affiliation(s)
- Jinwu Wang
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Leyi Cai
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Linzhen Xie
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Hua Chen
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Xiaoshan Guo
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China
| | - Kehe Yu
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, XueYuan West Road, Luheng District, Wenzhou, 325000, Zhejiang Province, People's Republic of China.
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Rizkallah M, Haddad M, Haykal G. Femoral head fracture in an adult patient with isolated posterior labrum avulsion recognized through the 'fleck' sign: technical tips. J Hip Preserv Surg 2019; 6:86-90. [PMID: 31069100 PMCID: PMC6501445 DOI: 10.1093/jhps/hnz006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/03/2019] [Indexed: 11/24/2022] Open
Abstract
Femoral head fractures in adults are known to be frequently associated with femoral neck fractures, acetabular fractures and sciatic nerve neurapraxia. Here, we report for the first time in the English medical literature the case of a 30-year-old patient having a Pipkin Type II comminuted femoral head fracture associated to an isolated acetabular labral osteochondral avulsion. This entity was diagnosed preoperatively through the presence of the acetabular ‘fleck’ sign recently described in adolescents with hip dislocation. This was of paramount importance knowing the key role of the acetabular labrum in physiological hip functioning. Therefore, a high index of suspicion of complete posterior acetabular labrum avulsion should be raised in front of a hip computed tomography scan showing the acetabular fleck sign even in an adult patient. This finding is important in posing the surgical indication and in completing the preoperative surgical planning in cases of femoral head fractures and dislocations.
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Affiliation(s)
- Maroun Rizkallah
- Orthopedic Surgery Department, Mount Lebanon Hospital, Faculty of Medicine, Saint Joseph University, Blvd. Camille Chamoun, Beirut, Lebanon
| | - Marwan Haddad
- Radiology Department, Mount Lebanon Hospital, Faculty of Medicine, Lebanese University, Blvd. Camille Chamoun, Beirut, Lebanon
| | - Gaby Haykal
- Orthopedic Surgery Department, Mount Lebanon Hospital, Faculty of Medicine, Saint Joseph University, Blvd. Camille Chamoun, Beirut, Lebanon
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Mei XY, Bhanot K, Tsvetkov D, Rajgopal R, Safir OA, Kuzyk PR. Current Uses of the Transtrochanteric Approach to the Hip: A Systematic Review. JBJS Rev 2018; 6:e2. [PMID: 29979233 DOI: 10.2106/jbjs.rvw.17.00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The indications and technique for the transtrochanteric approach to the hip have evolved greatly since its initial popularization in the 1960s. The purpose of this systematic review was to assess current uses of this approach on the basis of indications, osteotomy technique, trochanteric fixation method, complications, and functional outcome. METHODS A comprehensive search of MEDLINE and Embase databases from January 2000 to July 2017 was performed in accordance with the PRISMA guidelines. Articles were divided into 3 major categories on the basis of the type of hip surgery performed: (1) primary arthroplasty, (2) revision arthroplasty, and (3) joint-preserving procedures. Patient data were then analyzed according to these 3 categories. RESULTS Seventy-six studies (5,028 hips), mainly of Level-IV evidence, were included. Four types of osteotomy were reported for a variety of indications. Rates of nonunion were 6.0% (303 of 5,028) across all studies, 4.2% (39 of 921) for primary arthroplasty, 6.7% (114 of 1,690) for revision arthroplasty, and 4.4% (56 of 1,278) for joint-preserving procedures. Rates of dislocation were 1.5% (14 of 921) for primary arthroplasty and 4.6% (77 of 1,690) for revision arthroplasty. The rate of osteonecrosis after joint-preserving procedures was 1.1% (14 of 1,278). Rates of deep infection were 1.1% (55 of 5,028) across all studies, 0.1% (1 of 921) for primary arthroplasty, 2.1% (36 of 1,690) for revision arthroplasty, and 0.6% (8 of 1,278) for joint-preserving procedures. CONCLUSIONS The transtrochanteric approach remains useful in cases requiring extensile exposure of the acetabulum or femoral medullary canal. However, trochanteric complications continue to pose a clinical challenge. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xin Y Mei
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
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Stirma GA, Uliana CS, Valenza WR, Abagge M. Surgical treatment of femoral head fractures through previously controlled hip luxation: four case series and literature review. Rev Bras Ortop 2018; 53:337-341. [PMID: 29892586 PMCID: PMC5993874 DOI: 10.1016/j.rboe.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To report a series of cases of patients treated by fracture of the femoral head through the Ganz pathway with controlled dislocation of the hip. METHOD All patients who were surgically treated with a Ganz access route for femoral head fractures were identified in a tertiary referral service for trauma. A review of medical records with X-rays and CT scans was carried out. The radiographic evaluation was classified according to Pipkin and the functional evaluation was performed through the application of the modified Harris Hip Score. Data regarding the quality of reduction, type of fixation, and postoperative complications were collected. RESULTS The sample consisted of three men and one woman, with a mean age of 30 years (20-51). Regarding Pipkin's classification, two cases were type I, one type II, and one type IV. Regarding the Harris Hip Score, an average of 65.75 points was obtained (range: 20-86). All cases had anatomical reduction in the intraoperative period. One case presented post-traumatic sciatic nerve praxis and evolved with infection at the surgical site. CONCLUSION Surgical treatment of femoral head fractures through controlled hip dislocation is a viable option and can be considered an alternative to classical approaches.
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Tratamento cirúrgico das fraturas da cabeça femoral através da luxação anterior controlada do quadril – Série de quatro casos e revisão da literatura. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
INTRODUCTION In this study, we aimed to investigate safety and efficacy of the trochanteric flip osteotomy with surgical hip dislocation technique in selected displaced acetabular and femoral head fractures with clinico-radiological outcome and potential complications. MATERIALS AND METHODS We retrospectively reviewed 32 patients from January 2009 to June 2014. Selected displaced acetabular fractures with comminution and/or cranial extension of posterior wall, marginal impaction, intraarticular fragment, femoral head fractures and hip fracture-dislocations were operated by this modified approach of trochanteric flip osteotomy and surgical hip dislocation. Patients were evaluated for fracture reduction, femoral head viability, trochanteric union, abduction power, and functional evaluation was done by Merle d'Aubigné-Postel scoring system. Minimum follow-up was 24 months. RESULTS Reduction was judged to be anatomical in 84.38% of cases, and within 1-3 millimetres in 9.38% of cases. All osteotomies healed in an anatomical position. Heterotopic ossification was found in 2 patients limited to Brooker class I. Osteonecrosis developed in 1 patient. 2 patients developed arthritis of the hip as sequelae of poor reduction. Abduction power was MRC 5/5 in all except in 1 patient (4/5). Mean Merle d'Aubigné-Postel score was 16.18; overall good to excellent result was achieved in 87.5% of cases. CONCLUSIONS Trochanteric flip osteotomy with surgical dislocation allows better intraarticular assessment, control of intraarticular fragments, assists accurate reduction and the fixation of complex acetabular and femoral head fractures, without compromising femoral head vascularity and abductor strength. This technique has provided excellent midterm results in the management of complex injuries around the hip.
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Zhao B, Li H, Yan J, Han LR, Yang XF. Pipkin type III femoral head fracture-dislocation combined with complicated acetabular fracture: A rare case report and literature review. Medicine (Baltimore) 2017; 96:e9214. [PMID: 29390346 PMCID: PMC5815758 DOI: 10.1097/md.0000000000009214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Pipkin III fracture, which is characterized by high risk of avascular necrosis of the femoral head, is extremely rare. It is more difficult to treat and has a worse prognosis when accompanied with severe acetabular fractures. Few studies show that both Pipkin type III femoral head fracture-dislocation and complicated acetabular fracture presented in one patient. PATIENT CONCERNS A 34-year-old male suffered a terrible traffic accident with a serious damage to the left side when he was sitting in the car's cockpit. Pelvic radiograph and 3-dimensional reconstruction of computed tomography revealed characteristics of fractures before the emergency operation. DIAGNOSIS Pipkin III fractures combined with complicated acetabular fracture. INTERVENTIONS Firstly, we used combined anterior and posterior approach for treatment to fix the femoral head fractures. Then, we completed anatomical reduction of fractures with countersunk head screw, hollow screw, and reconstruction plate. OUTCOMES At the 12-months follow-up, the patient could walk freely and perform activities of daily living without necrosis of femoral head and heterotopic ossification. LESSONS Although there are serious complications in Pipkin III fractures combined with complicated acetabular fracture, early surgical treatment with appropriate approach and fixation could get satisfactory results.
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Schweitzer D, Klaber I, Zamora T, Amenábar PP, Botello E. Surgical dislocation of the hip without trochanteric osteotomy. J Orthop Surg (Hong Kong) 2017; 25:2309499016684414. [PMID: 29185379 DOI: 10.1177/2309499016684414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Surgical dislocation of the hip remains an important alternative in hip preservation surgery, especially when a dynamic access to the hip is needed and arthroscopy is not a suitable option. We describe a novel technique for operative dislocation of the hip without trochanteric osteotomy and the clinical results of our patients. METHODS Surgical dislocation of the hip without trochanteric osteotomy was done through a modified lateral approach in all of the cases. A review of demographic, clinical, and radiological data was done in all of the patients operated with this technique between 2010 and 2015. Complications, walking aids, weight-bearing status, and modified Harris Hip Score (mHHS) were also recorded. RESULTS Six surgical dislocations of the hip were carried out. Indications were tumor resection in five and bulletectomy in one hip. There were two women (four hips) and two men. Mean age was 19 ± 3.8 years. Median follow-up was 2.5 years (range 2-4.5 years). Median mHHS was 92 (90-96). There were no intraoperative nor postoperative complications. CONCLUSIONS Surgical dislocation of the hip without trochanteric osteotomy through a modified lateral approach appears to be a safe, simpler, and effective alternative.
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Affiliation(s)
- Daniel Schweitzer
- Orthopedic Surgery Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ianiv Klaber
- Orthopedic Surgery Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomás Zamora
- Orthopedic Surgery Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro Pablo Amenábar
- Orthopedic Surgery Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Botello
- Orthopedic Surgery Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Abstract
BACKGROUND Femoral head fractures are rare injuries; incongruency and instability are indications for surgical intervention. Anterior, posterior, and transtrochanteric surgical approaches have been proposed, but the exposure is limited with classical approaches. Surgical hip dislocation allows for a 360° view of the head and may facilitate a reduction in selected head fractures, but to our knowledge, few studies have reported on the results with this technique. We therefore report on the (1) quality of fracture reduction; (2) modified Harris hip score at a minimum of 2 years (mean, 6 years, range, 26-122 months); and (3) frequency of complications, including avascular necrosis (AVN), arthritis development, and heterotopic ossification, in a case series of patients with femoral head fractures treated with this approach. DESCRIPTION OF TECHNIQUE The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. Using this technique we are able to reduce all displaced femoral head fractures under direct view. Definitive fixation is performed through this approach with 2.7-mm nonabsorbable screws. The same technique may be used also for Pipkin IV fractures to fix transverse, T-type, posterior wall, or posterior column acetabular fracture. METHODS Between 2004 and 2011, we used this approach to manage all displaced femoral head fractures in patients younger than 55 years old. A total of 17 patients were thus treated; of those three were lost to followup before 2 years, and one was excluded from study because of severe preoperative neurological impairment, leaving 13 for analysis here. Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs. Outcomes were evaluated with the modified Harris hip score. Minimum followup was 24 months (mean, 77 months; SD, 32.8 months). RESULTS Fracture reduction was anatomic in eight hips and imperfect in five. Mean clinical score was 82 points (SD, 7.7). One patient developed symptomatic femoral head AVN and underwent total hip arthroplasty 4 years after the index procedure; no other patient underwent arthroplasty. Besides this patient, signs of arthritis (Grade I according to Tönnis classification) were found in one patient and heterotopic ossification was recorded in two patients, but neither was symptomatic. CONCLUSIONS Our experience with surgical dislocation shows clinical results comparable to previously reported outcomes in femoral head fractures treated with common approaches; we also present a similar rate of AVN and a lower rate of posttraumatic arthritis, but a higher risk of heterotopic ossification. Further case-control studies are necessary to confirm these statements. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Ganz Surgical Dislocation of the Hip Is a Safe Technique for Operative Treatment of Pipkin Fractures. Results of a Prospective Trial. J Orthop Trauma 2015; 29:544-8. [PMID: 26595593 DOI: 10.1097/bot.0000000000000399] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The primary objective was to study the incidence of femoral head osteonecrosis after Ganz approach for Pipkin fracture dislocations. Clinico-radiological and functional outcomes were also studied. DESIGN Prospective, nonrandomised. SETTING Tertiary care trauma center. PATIENTS Twenty-eight patients with type I/II Pipkin fracture dislocation reduced within 6 hours of injury. INTERVENTION The displaced head fracture was addressed through safe surgical dislocation after urgent closed reduction of the hip. OUTCOME MEASUREMENTS Incidence of osteonecrosis using radiographs and functional outcome using modified Merle d'Aubigne and Oxford scores were studied. RESULTS Twenty-six fractures were fixed, and 2 type I fractures were excised. Twenty-six of 28 patients were followed up for a mean of 36 months. There was no osteonecrosis. All fractures and osteotomies had united. The mean modified Merle d'Aubigne score was 16.5 (14-18), and the mean Oxford score was 42.65 (38-48). CONCLUSIONS Safe surgical dislocation provides satisfactory results in Pipkin fracture dislocations. The incidence of osteonecrosis is not increased in patients undergoing early joint reduction. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Helms JR, Nowotarski PJ. Posterior wall acetabulum fracture-dislocation with subsequent ipsilateral pipkin IV fracture-dislocation: How many hits can a hip take? Trauma Case Rep 2015; 1:65-72. [PMID: 30101179 PMCID: PMC6082501 DOI: 10.1016/j.tcr.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 11/28/2022] Open
Abstract
The treatment of acetabulum fractures is a technically-demanding task for orthopaedic trauma surgeons. The treatment of femoral head fractures associated with acetabulum fractures, pipkin IV fractures, presents difficulty as usually the femoral head fracture requires treatment through an anterior approach and the acetabulum fracture, which is commonly a posterior wall fracture, requires treatment through a posterior approach. Recently, surgical dislocation of the hip has become an accepted option for treatment of these fractures as it allows treatment of the femoral head fracture and posterior wall acetabulum fracture through one approach. However, dual anterior and posterior approaches are acceptable. We present 15 year follow up of an 18 year old female who underwent open reduction internal fixation of a posterior wall acetabulum fracture through a Kocher–Langenbeck approach. Four months later the patient sustained a second fracture dislocation of the same hip, this time a femoral head fracture with an associated posterior wall acetabulum fracture that was treated with a Kocher–Langenbeck approach for the revision acetabulum and a approach for the femoral head fracture. At fifteen years the patient had a Merle d'Aubigne score of 15 and a Harris hip score of 71. She was gainfully employed and subjectively happy with her surgical result. While treatment of pipkin IV fracture dislocations can be treated through a surgical dislocation of the hip, dual surgical approaches are a viable option in certain cases.
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Affiliation(s)
- Jonathan R Helms
- University of Tennessee-Chattanooga Department of Orthopaedics, USA
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Affiliation(s)
- Geoffrey S Marecek
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, 1520 San Pablo, Suite 2000, Los Angeles, CA 90033
| | - John A Scolaro
- Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868
| | - Milton L Chip Routt
- University of Texas-Health Sciences Center at Houston, 6431 Fannin Street, Houston, TX 77030
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Jauregui JJ, Clayton A, Kapadia BH, Cherian JJ, Issa K, Mont MA. Total hip arthroplasty for acute acetabular fractures: a review of the literature. Expert Rev Med Devices 2015; 12:287-95. [DOI: 10.1586/17434440.2015.1009828] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Posterior fracture dislocation of the femoral head is a rare entity usually requiring open reduction and internal fixation. Results of different fixation methods have been reported, including countersinking screws, headless screws, and bioabsorbable implants. Osteochondral autologous transfer (mosaicplasty) is an established method of treatment of full thickness cartilage defects of the knee, ankle, and elbow. At our institution, posterior fracture-dislocations of the femoral head were treated with femoral head fragment fixation using osteochondral autografts through surgical hip dislocation. Osteochondral plugs were harvested from the non-weight-bearing area of the lateral femoral condyle of the knee and used for fixation of the reduced fragment. This article details the technique and its application.
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Percutaneous screw fixation for a femoral head fracture: a case report. Arch Orthop Trauma Surg 2014; 134:371-4. [PMID: 24323060 DOI: 10.1007/s00402-013-1888-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Indexed: 10/25/2022]
Abstract
Femoral head fracture associated with hip dislocation is relatively rare but very severe injury. Due to its severity and the need of joint exposure for the reduction of femoral head fracture, the surgical treatment cannot but accompany many complications, including the osteonecrosis of the femoral head, heterotopic ossification, and post-traumatic osteoarthritis. We report a case of less invasive percutaneous screw fixation for the femoral head fracture with excellent clinical result. Post operatively, the fracture was healed, and no acute complication was observed. At 4 years post operation, full Harris hip score was achieved, and there were no osteonecrosis of the femoral head, no heterotopic ossification, and no post-traumatic osteoarthritis. We suggest attempting less invasive percutaneous screw fixation for the femoral head fracture.
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Abstract
A more detailed understanding of the anatomy of the medial femoral circumflex artery enabled the development of the modern technique for surgical hip dislocation. Although the surgical hip dislocation is best known as an open method for treating femoroacetabular impingement, it allows the surgeon to address a variety of different hip pathologies, including femoral head and posterior wall acetabular fractures, chondral defects requiring cartilage restoration techniques, and excision of benign tumors. When the technique of an extended retinacular flap is added, surgeons are able to perform intra-articular osteotomies and open reduction of slipped capital femoral epiphysis while preserving the blood supply to the femoral head. The surgical hip dislocation allows direct observation of both intra-articular and extra-articular impingement and a means of correcting both during 1 procedure. The downsides of the surgical hip dislocation are largely related to the trochanteric flip osteotomy, with up to half of patients reporting mild residual lateral hip pain 1 year postoperatively. Trochanteric nonunion and residual abductor weakness are also potential complications of the surgical hip dislocation technique. Several studies have shown improved pain and functional outcomes in short-term and mid-term follow-up after treatment of femoroacetabular impingement. It has a low complication rate in the hands of experienced surgeons and is an important technique for addressing complex intra-articular hip pathology that would be technically challenging arthroscopically.
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Oransky M, Martinelli N, Sanzarello I, Papapietro N. Fractures of the femoral head: a long-term follow-up study. Musculoskelet Surg 2012; 96:95-9. [PMID: 22389008 DOI: 10.1007/s12306-012-0182-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 02/14/2012] [Indexed: 05/05/2023]
Abstract
The femoral head fracture has become an increasingly frequent injury, usually sustained by individuals during high-energy trauma. Regardless of the type of treatment, long-term consequences, as avascular necrosis, post-traumatic arthritis, and heterotopic ossification, may complicate the clinical outcome leading to variable degree of disability. The aim of this study was to review the clinical and radiological long-term follow-up of patients with a fracture of the femoral head. Between January 1985 and January 2002, twenty-one patients with mean age 42.0 ± 15.9 years (range, 21-70 years) with a fracture of the femoral head were evaluated retrospectively. According to Pipkin's classification, there were four type I, nine type II, and eight type IV fractures. Functional outcomes were measured using the Merle d'Aubigné-Postel and Thompson-Epstein scoring scale. Heterotopic calcifications was graded according to the Brooker classification. All patients were followed up from 12 to 210 months, with an average of 81.19 ± 37.4 months. The average Merle d'Aubigné-Postel score was 12.9 ± 4.5. According to the Thompson-Epstein criteria, eight patients had excellent results, eight patients good, two patients fair, and three patients poor results. Overall, almost all (95. 2%) patients were determined to have radiographic criteria of post-traumatic arthritis (PA). Ten patients (47.6%) had a mild PA, seven patients (33.3%) had a moderate PA, and three patients (14.2%) had a severe PA. Open reduction and internal fixation of the fragments provided better results in comparison to excision. Although degenerative changes of the hip were observed in almost all patients, most severe case occurred in the excision group.
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Affiliation(s)
- M Oransky
- Department of Orthopaedic and Trauma Surgery, Aurelia Hospital, Rome, Italy
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Dislocated intra-articular femoral head fracture associated with fracture-dislocation of the hip and acetabulum: report of 12 cases and technical notes on surgical intervention. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:557-64. [DOI: 10.1007/s00590-012-1027-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
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Lim BH, Jang SW, Park YS, Lim SJ. Open repair and arthroscopic follow-up of severely delaminated femoral head cartilage associated with traumatic obturator fracture-dislocation of the hip. Orthopedics 2011; 34:199. [PMID: 21667908 DOI: 10.3928/01477447-20110427-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article describes an unusual case of a young adult with traumatic obturator fracture-dislocation of the hip, involving a large femoral head fragment and severe delamination of articular cartilage. The dislocation was irreducible by closed reduction because of interposing soft tissues, including the rectus femoris and iliopsoas muscles, and torn joint capsules, and therefore, open reduction was performed using an anterolateral approach in the lateral decubitus position. The large femoral head fragment was released from the ligamentum teres and fixed to the dislocated femoral head with headless screws. The severely delaminated femoral head cartilage was repaired with suture anchors and absorbable sutures. The patient was kept nonweight bearing for 6 weeks postoperatively, and was then allowed to resume full weight bearing gradually. He returned to normal activities of daily living at 14 weeks. At 9 months postoperatively, arthroscopic examination showed complete healing of the fracture and cartilage lesions, and at 12-month follow-up, there was no clinical or radiographic evidence of arthritis or osteonecrosis. The patient had no pain or limp, and achieved an excellent result according to Epstein's clinical evaluation criteria. To our knowledge, no previous report exists on the arthroscopic follow-up of a repaired femoral head cartilage in patients with obturator fracture-dislocation of the hip along with a large femoral head fragment and severe delamination of articular cartilage.
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Affiliation(s)
- Byung-Ho Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Chen ZW, Zhai WL, Ding ZQ, Lian KJ, Kang LQ, Guo LX, Liu H, Lin B. Operative versus nonoperative management of Pipkin type-II fractures associated with posterior hip dislocation. Orthopedics 2011; 34:350. [PMID: 21598886 DOI: 10.3928/01477447-20110317-09] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Little has been written on randomized, controlled studies of operative versus nonoperative management of Pipkin type-II fractures associated with posterior dislocation of the hip. It is difficult to validate the optimal management of these fractures. The goals of this study were to (1) evaluate the results of conservative and surgical treatment for Pipkin type-II fractures associated with posterior dislocation of the hip and supply the optimal management for these fractures and (2) identify whether the Smith-Petersen approach is a safe and reliable surgical approach for Pipkin type-II fractures.Twenty-four patients were randomly divided into 2 groups: the conservative group (n=12) was treated by closed reduction, and the surgical group (n=12) was treated by primary open reduction internal fixation (ORIF) by bioabsorbable screws via a Smith-Petersen approach. Minimum follow-up was 24 months. Functional outcome was measured using the Thompson and Epstein score and the d'Aubigné-Postel score. Heterotopic ossification was classified based on the Brooker classification. The outcome of the conservative group was worse than that of the surgical group (P=.037). Two patients in the conservative group needed joint replacement for avascular necrosis of the femoral head. Heterotopic ossification was found in 6 patients (1 patient in the conservative group and 5 in the surgical group).Primary ORIF by bioabsorbable screws via a Smith-Petersen approach is an effective treatment for Pipkin type-II fractures associated with posterior dislocation.
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Affiliation(s)
- Zhi-wen Chen
- Department of Orthopedics, 175th Hospital of PLA, Traumatic Orthopedics Center of PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian Province, PR China
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Chen ZW, Lin B, Zhai WL, Guo ZM, Liang Z, Zheng JP, Lian KJ, Ding ZQ. Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial. INTERNATIONAL ORTHOPAEDICS 2010; 35:1077-81. [PMID: 20680276 DOI: 10.1007/s00264-010-1087-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 04/28/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the long-term results of conservative and surgical fragment excision treatment in patients with Pipkin type 1 fractures of the femoral head associated with posterior dislocation of the hip by a randomised controlled trial. Sixteen patients were randomly divided into two groups: the conservative group was treated by closed reduction, and the surgical group was treated by closed reduction followed with fragment excision. Functional outcome was determined using the Thompson and Epstein score and the Merle d'Aubigne and Postel score. Outcome of the conservative group was worse than that of the surgical group (p = 0.032). The randomised controlled trial proves surgical fragment excision after closed reduction is an effective treatment for Pipkin type 1 fractures.
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Affiliation(s)
- Zhi-wen Chen
- Department of Orthopaedics, the 175th Hospital of PLA, Traumatic Orthopaedics Center of PLA, Zhangzhou Fujian Province, People's Republic of China.
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Abstract
Fractures of the femoral head (Pipkin fractures) are relatively uncommon. In cases of immediate, gentle reposition and considerate soft tissue treatment during operative treatment, Pipkin 1 and 2fractures can heal with good long-term results. However, some long-term problems regularly occur. Conservative therapy is possible in cases of anatomic articulation or the presence of only very small fragments that do not compromise articulation after closed reduction. Differentiated indications for conservative treatment in Pipkin 1 and Pipkin 2 fractures can result in a better outcome than operative treatment. All other fractures should be treated operatively. The approach has to be adapted to fragment size and location. Small fragments in Pipkin 1 fractures can simply be removed, but larger fragments in Pipkin 1 and Pipkin 2 fractures should be fixed, preferably via an anterior approach. Pipkin 3 fractures generally require total hip arthroplasty. Pipkin 4 fractures have a relatively poor outcome. The strategy of treatment depends on the necessity of operative fixation of the acetabular fracture and the size of the femoral fragment. The anterior approach is preferred in cases of stable joint situations with only a small acetabular rim fragment, and in cases of instability the dorsal approach is preferred. Surgical luxation can be advantageous for the treatment of Pipkin 4 fractures.
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Letter to the editor: Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures. Clin Orthop Relat Res 2010; 468:906-7. [PMID: 20024632 PMCID: PMC2816744 DOI: 10.1007/s11999-009-1200-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Management, complications and clinical results of femoral head fractures. Injury 2009; 40:1245-51. [PMID: 19897188 DOI: 10.1016/j.injury.2009.10.024] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/12/2009] [Accepted: 10/15/2009] [Indexed: 02/02/2023]
Abstract
A systematic review of the literature was conducted to investigate data regarding femoral head fractures, particularly focusing on their management, complications and clinical results. Twenty-nine eligible articles, meeting prespecified inclusion criteria, reported on 453 femoral head fractures in 450 patients (mean age of 38.9 years with a mean follow-up of 55.6 months). 84.3% of patients had been victims of an automobile accident. The most widespread classification scheme used was that of Pipkin (65.4% of cases) whereas clinical results were evaluated mainly according to Thompson-Epstein criteria (63.3% of cases). Fracture-dislocations, in their majority, were managed with emergent closed reduction, followed by definite treatment (closed or open), aiming at anatomic restoration of both fracture and joint incongruity. Regarding Pipkin 1 subtype, fractured fragment excision seems to give better results compared to ORIF (p=0.07), while for the more challenging Pipkin 2 fractures the principles of anatomic reduction and stable fixation should be applied. Wound infection was encountered with a rate of 3.2% of surgical cases and sciatic nerve palsy complicated 3.95% of fracture-dislocations. Major late complications included avascular necrosis (11.9%), post-traumatic arthritis (20%) and heterotopic ossification (16.8%). Neither the trochanteric-flip nor the anterior approach seems to put in more danger the femoral head blood supply compared to the posterior one, with the former giving promising long-term functional results and lower incidence of major complication rates.
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Osgood GM. Posterior wall acetabular fractures: update on surgical indications, fixation techniques and outcome measurements. CURRENT ORTHOPAEDIC PRACTICE 2009. [DOI: 10.1097/bco.0b013e3181b3a5f2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures: a systematic review. INTERNATIONAL ORTHOPAEDICS 2009; 34:319-22. [PMID: 19680651 DOI: 10.1007/s00264-009-0849-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 07/18/2009] [Accepted: 07/18/2009] [Indexed: 12/21/2022]
Abstract
Heterotopic ossification (HO) and avascular necrosis (AVN) have been identified as post-traumatic complications of femoral head fractures and may lead to a restriction in hip function and permanent disability. The question of which surgical approach is the best for the femoral head fracture and its relationship with HO and AVN remains controversial. We conducted a systematic review in which all published studies were evaluated. We performed a literature search in MEDLINE, PubMed, EMBASE, MD Consult, and the Cochrane Controlled Trial Register from 1980 to April 2009. We found ten appropriate studies, describing 176 patients. A lower percentage of patients treated with a trochanteric flip approach was reported with HO than patients treated with anterior or posterior approach (33.3% versus 42.1% and 36.9%, respectively), although the difference was not statistically significant. The incidence of AVN was highest in the posterior approach group (16.9%), and subsequently with the trochanteric flip approach (12.5%) and the anterior group (7.9%). The investigators concluded that the use of the anterior approach may result in a higher risk for HO and the posterior approach may result in a higher risk for AVN. A new, posterior-based approach of trochanteric flip seems to be a better approach for femoral head fractures. A further case-control study would be appropriate to confirm the findings in our systematic review.
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