DIAGNOSIS AND TREATMENT OF ACETABULAR LABRUM INJURY IN PIPKIN FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CHENZhiwei , LIANGXianyong , WUJunxing , CUIJuncheng , TANGZhibin , FANWeijie , LIChun , WUWente , DAIZhu

Department of Orthopedics, First Affiliated Hospital, University of South China, Hengyang Hunan, 421001, P. R. China;

Corresponding author：

CHENZhiwei, Email: czw9915@sina.com

Keywords：

Pipkin fracture; Acetabular labrum injury; Trochanteric osteotomy; Suture anchor

DOI：

10.7507/1002-1892.20150004

Video：

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Objective To observe the characteristics of acetabular labrum injury in Pipkin fractures and the effectiveness of repairing the labrum with suture anchor. Methods Between July 2010 and July 2013, 10 cases of Pipkin fractures accompanied by acetabular labrum injury were treated. There were 7 males and 3 females with an average age of 32.5 years (range, 24-56 years). The causes of injury included traffic accident in 8 cases and falling from height in 2 cases. According to the Pipkin classification criteria, there were 6 cases of type Ⅱ, 2 cases of type Ⅲ, and 2 cases of type Ⅳ. The average interval from injury to operation was 8 days (range, 6-14 days). All the patients underwent open reduction and internal fixation through transtrochanteric approach with trochanteric osteotomy, and repair the labrum with suture anchor. The effectiveness was evaluated according to the Thompson & Epstein scoring scales after operation. Results All incisions healed primarily without early complication of deep infection or deep vein thrombosis of lower limb. All the cases were followed up 22 months on average (range, 12-48 months). X-ray films showed that all osteotomies and acetabular fractures healed within 3-4 months, femoral head and femoral neck fracture healed within 6-11 months. MRI examinations showed that all repaired acetabular labrums well healed. One case had necrosis of the femoral head at 12 months after operation, and was treated by total hip arthroplasty. According to the Thompson & Epstein scoring scales at last follow-up, the results were excellent in 5 cases, good in 3 cases, fair in 1 case and poor in 1 case, with an excellent and good rate of 80%. Conclusion The diagnosis of acetabular labrum injury can be easily missed during Pipkin fracture, preoperative diagnosis should be combined with hip MRI. Trochanteric osteotomy through transtrochanteric approach, and repairing the labrum with suture anchor can restore the hip function effectively.

Citation： CHENZhiwei, LIANGXianyong, WUJunxing, CUIJuncheng, TANGZhibin, FANWeijie, LIChun, WUWente, DAIZhu. DIAGNOSIS AND TREATMENT OF ACETABULAR LABRUM INJURY IN PIPKIN FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 14-18. doi: 10.7507/1002-1892.20150004 Copy

1.	Matsuda DK. A rare fracture, an even rarer trauma:the arthroscopic reduction and internal fixation of an isolated femoral head fracture. Arthroscopy, 2009, 25(4):408-412.
2.	卢世璧, 王岩, 周勇刚, 等. 坎贝尔骨科手术学. 11版. 北京:人民军医出版社, 2009:298.
3.	Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twentyone years. J Bone Joint Surg (Am), 1951, 33-A (3):746-778.
4.	Henle P, Koen P, Siebenrock KA. Femoral head injuries:which treatment strategy can be recommended? Injury, 2007, 38(4):478-488.
5.	Ranawat AS, Kelly BT. Function of the labrum and management of labral pathology. Oper Tech Orthop, 2005, 15:239-46.
6.	Choi JY, Kang HS, Hong SH, et al. Optimization of the contrast mixture ratio for simultaneous direct MR and CT arthrography:an in vitro study. Korean J Radiol, 2008, 9(6):520-525.
7.	Smith TO, Hilton G, Toms AP, et al. The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography:a meta-analysis. Eur Radiol, 2011, 21(4):863-874.
8.	Jin W, Kim KI, Rhyu KH, et al. Sonographic evaluation of anterosuperior hip labral tears with magnetic resonance arthrographic and surgical correlation. J Ultrasound Med, 2012, 31(3):439-447.
9.	Kantarci F, Ozpeynirci Y, Unlu M, et al. Cross-sectional area of the labrum:role in the diagnosis of anterior acetabular labral tears. Eur Radiol, 2012, 22(6):1350-1356.
10.	Guo JJ, Tang N, Yang HL, et al. Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures:a systematic review. Int Orthop, 2010, 34(3):319-322.
11.	Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12):1245-1251.
12.	Solberg BD, Moon CN, Franco DP. Use of a trochanteric flip osteotomy improves outcomes in Pipkin Ⅳ fractures. Clin Orthop Relat Res, 2009, 467(4):929-933.
13.	Ansari A, Day AC. Letter to the editor:Use of a trochanteric flip osteotomy improves outcomes in Pipkin Ⅳ fractures. Clin Orthop Relat Res, 2010, 468(3):906-907.
14.	陈志伟, 戴祝, 廖瑛, 等. 经转子入路大转子截骨治疗Ⅳ型Pipkin骨折. 中国修复重建外科杂志, 2011, 25(10):1184-1187.
15.	Ebraheim NA, Patil V, Liu J, et al. Sliding trochanteric osteotomy in acetabulary fractures:a review of 30 cases. Injury, 2007, 38(10):1177-1182.
16.	Haemer JM, Carter DR, Giori NJ. The low permeability of healthy meniscus and labrum limit articular cartilage consolidation and maintain fluid load support in the knee and hip. J Biomech, 2012, 45(8):1450-1456.
17.	Song Y, Ito H, Kourtis L, et al. Articular cartilage friction increases in hip joints after the removal of acetabular labrum. J Biomech, 2012, 45(3):524-530.
18.	Haviv B, O'Donnell J. Arthroscopic treatment for acetabular labral tears of the hip without bony dysmorphism. Am J Sports Med, 2011, 39(Suppl):79s-84s.
19.	Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears:diagnosis, repair, and a method for labral reconstruction. Clin Sports Med, 2011, 30(2):317-329.
20.	Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement:mean 3.5-year follow-up. Am J Sports Med, 2012, 40(5):1015-1021.
21.	Cadet ER, Chan AK, Vorys GC, et al. Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med, 2012, 40(10):2218-2223.
22.	Espinosa N, Rothenfluh DA, Beck M, et al. Treatment of femoroacetabular impingement:preliminary results of labral refixation. J Bone Joint Surg (Am), 2006, 88(5):925-935.
23.	Petersen W, Petersen F, Tillmann B. Structure andvascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg, 2003, 123(6):283-288.
24.	Kalhor M, Horowitz K, Beck M, et al. Vascular supply to the acetabular labrum. J Bone Joint Surg (Am), 2010, 92(15):2570-2575.
25.	Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum:a histologic assessment of healing in an ovine model. Arthroscopy, 2007, 23(4):376-380.

1. Matsuda DK. A rare fracture, an even rarer trauma:the arthroscopic reduction and internal fixation of an isolated femoral head fracture. Arthroscopy, 2009, 25(4):408-412.
2. 卢世璧, 王岩, 周勇刚, 等. 坎贝尔骨科手术学. 11版. 北京:人民军医出版社, 2009:298.
3. Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twentyone years. J Bone Joint Surg (Am), 1951, 33-A (3):746-778.
4. Henle P, Koen P, Siebenrock KA. Femoral head injuries:which treatment strategy can be recommended? Injury, 2007, 38(4):478-488.
5. Ranawat AS, Kelly BT. Function of the labrum and management of labral pathology. Oper Tech Orthop, 2005, 15:239-46.
6. Choi JY, Kang HS, Hong SH, et al. Optimization of the contrast mixture ratio for simultaneous direct MR and CT arthrography:an in vitro study. Korean J Radiol, 2008, 9(6):520-525.
7. Smith TO, Hilton G, Toms AP, et al. The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography:a meta-analysis. Eur Radiol, 2011, 21(4):863-874.
8. Jin W, Kim KI, Rhyu KH, et al. Sonographic evaluation of anterosuperior hip labral tears with magnetic resonance arthrographic and surgical correlation. J Ultrasound Med, 2012, 31(3):439-447.
9. Kantarci F, Ozpeynirci Y, Unlu M, et al. Cross-sectional area of the labrum:role in the diagnosis of anterior acetabular labral tears. Eur Radiol, 2012, 22(6):1350-1356.
10. Guo JJ, Tang N, Yang HL, et al. Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures:a systematic review. Int Orthop, 2010, 34(3):319-322.
11. Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12):1245-1251.
12. Solberg BD, Moon CN, Franco DP. Use of a trochanteric flip osteotomy improves outcomes in Pipkin Ⅳ fractures. Clin Orthop Relat Res, 2009, 467(4):929-933.
13. Ansari A, Day AC. Letter to the editor:Use of a trochanteric flip osteotomy improves outcomes in Pipkin Ⅳ fractures. Clin Orthop Relat Res, 2010, 468(3):906-907.
14. 陈志伟, 戴祝, 廖瑛, 等. 经转子入路大转子截骨治疗Ⅳ型Pipkin骨折. 中国修复重建外科杂志, 2011, 25(10):1184-1187.
15. Ebraheim NA, Patil V, Liu J, et al. Sliding trochanteric osteotomy in acetabulary fractures:a review of 30 cases. Injury, 2007, 38(10):1177-1182.
16. Haemer JM, Carter DR, Giori NJ. The low permeability of healthy meniscus and labrum limit articular cartilage consolidation and maintain fluid load support in the knee and hip. J Biomech, 2012, 45(8):1450-1456.
17. Song Y, Ito H, Kourtis L, et al. Articular cartilage friction increases in hip joints after the removal of acetabular labrum. J Biomech, 2012, 45(3):524-530.
18. Haviv B, O'Donnell J. Arthroscopic treatment for acetabular labral tears of the hip without bony dysmorphism. Am J Sports Med, 2011, 39(Suppl):79s-84s.
19. Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears:diagnosis, repair, and a method for labral reconstruction. Clin Sports Med, 2011, 30(2):317-329.
20. Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement:mean 3.5-year follow-up. Am J Sports Med, 2012, 40(5):1015-1021.
21. Cadet ER, Chan AK, Vorys GC, et al. Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med, 2012, 40(10):2218-2223.
22. Espinosa N, Rothenfluh DA, Beck M, et al. Treatment of femoroacetabular impingement:preliminary results of labral refixation. J Bone Joint Surg (Am), 2006, 88(5):925-935.
23. Petersen W, Petersen F, Tillmann B. Structure andvascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg, 2003, 123(6):283-288.
24. Kalhor M, Horowitz K, Beck M, et al. Vascular supply to the acetabular labrum. J Bone Joint Surg (Am), 2010, 92(15):2570-2575.
25. Philippon MJ, Arnoczky SP, Torrie A. Arthroscopic repair of the acetabular labrum:a histologic assessment of healing in an ovine model. Arthroscopy, 2007, 23(4):376-380.

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DIAGNOSIS AND TREATMENT OF ACETABULAR LABRUM INJURY IN PIPKIN FRACTURE

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