Modified Hueter direct anterior approach for treatment of Pipkin type <b>Ⅰ</b> and <b>Ⅱ</b> femoral head fractures _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Qin ^1,2 , HUANG Fuguo ¹ , XIANG Zhou ¹ , FANG Yue ¹ , ZHONG Gang ¹ , YI Min ¹ , ZHAO Xiaodan ¹ ,  LIU Lei ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopaedics, Tibetan Chengdu Office Branch Hospital of West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LIU Lei, Email: liuinsistence@163.com

Keywords：

Femoral head fracture; posterior dislocation of hip joint; modified Hueter direct anterior approach

DOI：

10.7507/1002-1892.201710073

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ObjectiveTo discuss the effectiveness of the modified Hueter direct anterior approach in treatment of Pipkin typeⅠ and Ⅱ femoral head fractures.MethodsBetween September 2014 and May 2016, 12 patients with Pipkin type Ⅰ and Ⅱ femoral head fractures were treated with the modified Hueter direct anterior approach. There were 8 males and 4 females, aged from 32 to 60 years (mean, 40.2 years). The disease causes included traffic accident injury in 9 cases and falling from height injury in 3 cases. According to Pipkin typing, 8 cases were rated as type Ⅰ and 4 cases as type Ⅱ. The interval of injury and admission was 2-28 hours (mean, 7.2 hours). Reduction was performed in all patients within 6 hours after admission, and then bone traction was given. The operation was performed in 3-7 days (mean, 4.3 days) after redution. The modified Hueter direct anterior approach was applied to expose and fix femoral head fractures by Herbert screws compressively. The operation time and intraoperative blood loss were recorded, and the effectiveness was evaluated according to the Thompson-Epstein scale at last follow-up.ResultsThe operation time was 80-130 minutes (mean, 97.5 minutes), and the intraoperative blood loss was 100-200 mL (mean, 130.2 mL). All fractures achieved anatomical reduction and successful fixation. All 12 patients were followed up 12-32 months (mean, 24.3 months). All patients achieved bone union in 15-20 weeks (mean, 16.3 weeks) and no wound infection, lateral femoral cutaneous nerve injury, osteonecrosis of the femoral head, or heterotopic ossification occurred. Traumatic arthritis occured in 3 patients. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 5 cases, good in 5 cases, fair in 2 cases, and the excellent and good rate was 83.3%.ConclusionThe modified Hueter direct anterior approach has the advantages of clear anatomic structure, less trauma, and shorter operation time, and it can effectively expose and fix the Pipkin typeⅠ and Ⅱ femoral head fractures.

Citation： LI Qin, HUANG Fuguo, XIANG Zhou, FANG Yue, ZHONG Gang, YI Min, ZHAO Xiaodan, LIU Lei. Modified Hueter direct anterior approach for treatment of Pipkin type Ⅰ and Ⅱ femoral head fractures . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(3): 334-337. doi: 10.7507/1002-1892.201710073 Copy

1.	Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12): 1245-1251.
2.	Henle P, Kloen P, Siebenrock KA. Femoral head injuries: Which treatment strategy can be recommended? Injury, 2007, 38(4): 478-488.
3.	Oransky M, Martinelli N, Sanzarello I, et al. Fractures of the femoral head: a long-term follow-up study. Musculoskelet Surg, 2012, 96(2): 95-99.
4.	倘艳锋, 刘又文, 朱英杰, 等. 髋关节外科脱位入路治疗股骨头骨折. 中国修复重建外科杂志, 2015, 29(11): 1327-1331.
5.	陈农, 董健, 潘福根. Pipkin 骨折的治疗及并发症的防治. 中国骨伤, 2009, 22(3): 229-230.
6.	Stannard JP, Harris HW, Volgas DA, et al. Functional outcome of patients with femoral head fractures associated with hip dislocations. Clin Orthop Relat Res, 2000, (377): 44-56.
7.	Swiontkowski MF, Thorpe M, Seiler JG, et al. Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin Ⅰ and Pipkin Ⅱ fractures. J Orthop Trauma, 1992, 6(4): 437-442.
8.	Droll KP, Broekhuyse H, O’Brien P. Fracture of the femoral head. J Am Acad Orthop Surg, 2007, 15(12): 716-727.
9.	Leslie MP, Wolinsky JP. Treatment of Femoral Head Fractures. Tech Orthop, 2010, 25(3): 155-159.
10.	Wang CG, Li YM, Zhang HF, et al. Anterior approach versus posterior approach for Pipkin Ⅰ and Ⅱ femoral head fractures: A systemic review and meta-analysis. Int J Surg, 2016, 27: 176-181.
11.	Rudert M, Horas K, Hoberg M, et al. The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint. BMC Musculoskelet Disord, 2016, 17: 57.
12.	Paillard P. Hip replacement by a minimal anterior approach. Int Orthop, 2007, 31 Suppl 1: S13-15.
13.	Pipkin G. Treatment of grade Ⅳ fracture-dislocation of the hip. J Bone Joint Surg (Am), 1957, 39-A(5): 1027-1042.
14.	Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg (Am), 1951, 33-A(3): 746-778.
15.	Epstein HC. Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Joint Surg (Am), 1974, 56(6): 1103-1127.
16.	Butler JE. Pipkin Type-Ⅱ fractures of the femoral head. J Bone Joint Surg (Am), 1981, 63(8): 1292-1296.
17.	Tripathy SK, Sen RK, Goyal T. Conservative versus surgical management of Pipkin type Ⅰ fractures associated with posterior dislocation of the hip: a randomised controlled trial. Int Orthop, 2011, 35(12): 1907-1908.
18.	Judet J, Judet R. The use of an artificial femoral head for arthroplasty of the hip joint. J Bone Joint Surg (Br), 1950, 32-B(2):166-173.
19.	O’Brien RM. The technic for insertion of femoral head prosthesis by the straight anterior or Hueter approach. Clin Orthop, 1955, 6: 22-26.
20.	Kurtz WJ, Vrabec GA. Fixation of femoral head fractures using the modified heuter direct anterior approach. J Orthop Trauma, 2009, 23(9): 675-680.

1. Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12): 1245-1251.
2. Henle P, Kloen P, Siebenrock KA. Femoral head injuries: Which treatment strategy can be recommended? Injury, 2007, 38(4): 478-488.
3. Oransky M, Martinelli N, Sanzarello I, et al. Fractures of the femoral head: a long-term follow-up study. Musculoskelet Surg, 2012, 96(2): 95-99.
4. 倘艳锋, 刘又文, 朱英杰, 等. 髋关节外科脱位入路治疗股骨头骨折. 中国修复重建外科杂志, 2015, 29(11): 1327-1331.
5. 陈农, 董健, 潘福根. Pipkin 骨折的治疗及并发症的防治. 中国骨伤, 2009, 22(3): 229-230.
6. Stannard JP, Harris HW, Volgas DA, et al. Functional outcome of patients with femoral head fractures associated with hip dislocations. Clin Orthop Relat Res, 2000, (377): 44-56.
7. Swiontkowski MF, Thorpe M, Seiler JG, et al. Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin Ⅰ and Pipkin Ⅱ fractures. J Orthop Trauma, 1992, 6(4): 437-442.
8. Droll KP, Broekhuyse H, O’Brien P. Fracture of the femoral head. J Am Acad Orthop Surg, 2007, 15(12): 716-727.
9. Leslie MP, Wolinsky JP. Treatment of Femoral Head Fractures. Tech Orthop, 2010, 25(3): 155-159.
10. Wang CG, Li YM, Zhang HF, et al. Anterior approach versus posterior approach for Pipkin Ⅰ and Ⅱ femoral head fractures: A systemic review and meta-analysis. Int J Surg, 2016, 27: 176-181.
11. Rudert M, Horas K, Hoberg M, et al. The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint. BMC Musculoskelet Disord, 2016, 17: 57.
12. Paillard P. Hip replacement by a minimal anterior approach. Int Orthop, 2007, 31 Suppl 1: S13-15.
13. Pipkin G. Treatment of grade Ⅳ fracture-dislocation of the hip. J Bone Joint Surg (Am), 1957, 39-A(5): 1027-1042.
14. Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg (Am), 1951, 33-A(3): 746-778.
15. Epstein HC. Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Joint Surg (Am), 1974, 56(6): 1103-1127.
16. Butler JE. Pipkin Type-Ⅱ fractures of the femoral head. J Bone Joint Surg (Am), 1981, 63(8): 1292-1296.
17. Tripathy SK, Sen RK, Goyal T. Conservative versus surgical management of Pipkin type Ⅰ fractures associated with posterior dislocation of the hip: a randomised controlled trial. Int Orthop, 2011, 35(12): 1907-1908.
18. Judet J, Judet R. The use of an artificial femoral head for arthroplasty of the hip joint. J Bone Joint Surg (Br), 1950, 32-B(2):166-173.
19. O’Brien RM. The technic for insertion of femoral head prosthesis by the straight anterior or Hueter approach. Clin Orthop, 1955, 6: 22-26.
20. Kurtz WJ, Vrabec GA. Fixation of femoral head fractures using the modified heuter direct anterior approach. J Orthop Trauma, 2009, 23(9): 675-680.

Chinese Journal of Reparative and Reconstructive Surgery

Modified Hueter direct anterior approach for treatment of Pipkin type Ⅰ and Ⅱ femoral head fractures

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