Objective To evaluate and compare the outcomes of simple closed reduction, selective fragment excision after closed reduction, and emergency fragment excision and reduction in the treatment of Pipkin type I fracture of femoral head associated with posterior dislocation of the hip. Methods Between January 2002 and January 2008, 24 patients with Pipkin type I fracture of the femoral head associated with posterior dislocation of the hip were treated with simple closed reduction (closed reduction group, n=8), with selective fragment excision after closed reduction (selective operation group, n=8), and with emergency fragment excision and reduction (emergency operation group, n=8). In the closed reduction group, there were 6 males and 2 females with an average age of 37.6 years (range, 19-56 years); injuries were caused by traffic accident in 6 cases, by fall ing from height in 1 case, and by crushing in 1 case with a mean disease duration of 3.1 hours (range, 1.0-7.5 hours); and the interval from injury to reduction was (4.00 ± 2.14) hours. In the selective operation group, there were 7 males and 1 female with an average age of 37.3 years (range, 21-59 years); injuries were caused by traffic accident in 7 cases and by fall ing from height in 1 case with a mean disease duration of 3.2 hours (range, 1.0-6.0 hours); and the interval from injury to reduction was (3.90 ± 1.47) hours. In the emergency operation group, there were 5 males and 3 females with an average age of 35.5 years (range, 20-58 years); injuries were caused by traffic accident in 5 cases, by fall ing from height in 1 case, and by crushing in 2 cases with a mean disease duration of 3.3 hours (range, 1.5-6.5 hours); and the interval from injury to open reduction was (5.10 ± 2.04) hours. There was no significant difference in the age, gender, disease duration, and interval from injury to reduction among 3 groups (P gt; 0.05). Results All wounds in selective operation group and emergency operation group healed primarily. All the patients were followed up 24 to 58 months (mean, 38.7 months). According to Thompson-Epstein system, the excellent and good rates were 50.0% (4/8) in the closed reduction group, 87.5% (7/8) in the selective operation group, and 87.5% (7/8) in the emergency operation group at 24 months after operation, showing significant difference among 3 groups (χ2=9.803, P=0.020). Heterotopic ossification was found in 1 case (12.5%) of the closed reduction group, in 4 cases (50.0%) of the selective operation group, and in 4 cases (50.0%) of the emergency operation group, and avascular necrosis of femoral head was found in 2 cases (25.0%) of the closed reduction group; there was no significant difference in compl ications among 3 groups (P gt; 0.05). Conclusion The treatment of Smith-Petersen approach and fragment excision by selective operation or emergency operation has similar outcome, which are better than the treatment of simple closed reduction.
ObjectiveTo discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. MethodsA retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type Ⅰ, 7 cases as type Ⅱ, 1 case as type Ⅲ, and 5 cases as type Ⅳ. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. ResultsPrimary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms[staging as Ⅱa and Ⅱb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage Ⅲb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade Ⅰ, 1 case of grade Ⅱ, and 1 case of grade Ⅲ based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. ConclusionSurgical hip dislocation approach can not only protect the residual vessels of the femoral head but also fully expose the acetabulum and femoral head, which is the ideal approach for the treatment of femoral head fractures.
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.
ObjectiveTo evaluate the short-term effectiveness of arthroscopic surgery combined with direct anterior approach for hip diseases.MethodsA retrospective study was performed on 23 cases with hip diseases (23 hips), who were treated with the arthroscopic surgery combined with direct anterior approach, between January 2015 and December 2016. There were 9 males and 14 females, aged from 27 to 49 years (mean, 38.6 years). There were 11 cases of posterior dislocation of the hip associated with femoral head fracture (Pipkin typeⅠ) and 7 cases of femoral neck fracture (Garden type Ⅳ). And the interval between injury and operation was 2-8 days (mean, 4.3 days). Five cases were osteonecrosis of femoral head at precollapse stage which were rated as stageⅡA according to Association Research Circulation Osseous (ARCO) classification system. The disease duration was 3-8 months (mean, 5.9 months). The preoperative Harris hip score, Oxford Hip Score (OHS), Postel score, and visual analogue scale (VAS) were 57.3±8.2, 11.2±3.6, 3.2±1.5, and 7.2±1.3, respectively.ResultsAll the wounds healed primarily. Lateral femoral nerve injury occurred in 3 cases. All patients were followed up 8-19 months (mean, 15.6 months). Bone union achieved in all patients after 14-19 weeks (mean, 15.8 weeks) and no secondary osteoarthritis or heterotopic ossification occurred. At last follow-up, the Harris hip score (92.5±5.3), OHS (36.5±5.9), and Postel score (14.2±2.6) were significantly higher than preoperative scores (t=45.274, P=0.000; t=36.586, P=0.000; t=32.486, P=0.000), and VAS score (1.8±0.9) was significantly lower than preoperative score (t=21.314, P=0.000).ConclusionArthroscopic surgery combined with direct anterior approach for hip diseases can effectively relieve pain, improve hip function, and obtain the satisfactory short-term effectiveness.
Objective To summarize the characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. Methods The clinical data of 4 patients with irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations between January 2010 and December 2019 were collected. There were 2 males and 2 females and the age ranged from 24 to 41 years, with an average age of 33.5 years. The cause of injury included traffic accident in 3 cases and falling in 1 case. Pipkin classification was 2 cases of type Ⅰ and 2 cases of type Ⅱ. The time from injury to operation was 1-2 days. The clinical features were that the hip joint of the affected limb was in a locked position, and the passive range of motion was poor. The affected limb was slightly flexed at the hip joint and shortened, in a state of neutral position or slight adduction and internal rotation. The imaging data suggested that the femoral head dislocated backward and upward, and the hard cortex of the posterior edge of the acetabulum was embedded in the cancellous bone of the femoral head, and the two were compressed and incarcerated. Patients of cases 1-3 underwent closed reduction of hip dislocation 1-2 times at 3, 1, and 3 hours after injury respectively, and femoral neck fracture occurred. The injury types changed to Pipkin type Ⅲ, and open reduction and internal fixation were performed. Patient of case 4 did not undergo closed reduction, but underwent open reduction and internal fixation directly. Results Patients of cases 1-3 were followed up 14, 17, and 12 months, respectively. They developed osteonecrosis of the femoral head at 9, 5, and 10 months after operation respectively, and all underwent total hip arthroplasty. Patient of case 4 was followed up 24 months and had no hip pain and limited mobility; the imaging data indicated that the internal fixator position was good and the fracture healed; no collapse or deformation of the femoral head was seen, and no osteonecrosis of the femoral head occurred. Conclusion Clinicians need to improve their understanding of the unique clinical features and imaging findings of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. It is suggested that open reduction and simultaneous fixation of femoral head fracture should be directly used to reduce the incidence of osteonecrosis of the femoral head.