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Schaffer NE, Luther L, Tatman LM, Mitchell PM. Femoral Head Fractures: Evaluation, Management, and Outcomes. J Am Acad Orthop Surg 2024:00124635-990000000-01025. [PMID: 38968607 DOI: 10.5435/jaaos-d-23-01121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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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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Caudron M, Gerset V, Tronc C, Tonetti J, Boudissa M. Anterior approaches in acetabular fractures: a true learning curve analysis. Acta Orthop Belg 2024; 90:17-25. [PMID: 38669644 DOI: 10.52628/90.1.10974] [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: 04/28/2024]
Abstract
Today, acetabular surgeons in training have to learn ilioinguinal and anterior intrapelvic approaches (AIP). The aim of this study was to describe the 5-years learning curve of a surgeon. Objective was to assess clinical and radiological results; and to assess factors which could influence this learning curve. Between November 2015 and May 2020, patients with an acetabular fracture operated by the surgeon during the 5-years learning curve with an anterior approach were included in this single-center retrospective study based on a prospective database. Epidemiological, operative, clinical, radiological and complications data's were collected. To assess learning-curve effect the series was divided into two groups: first 2.5-years and last 2-years. Subgroup analysis were performed according to the surgical approach, to the reduction quality and the prognostic factors. In total, 46 patients were included, 23 in period 1 and 23 in period 2. 16 patients (35%) had ilioinguinal approach and 30 patients (65%) had modified Stoppa-Cole approach. At mean follow-up of 24 months, 38 patients (83%) were reviewed. Anatomical reduction (< 1 mm) was achieved in 28 patients (60.9%) with a 9% rate of perioperative complications and 37% rate of post-operative complications. In conclusion, this study gives a realistic overview of the learning curve of anterior approaches in acetabular fractures surgery. Our results should encourage surgeons, while keeping in mind how much this surgery can be challenging, with high rate of complications and difficulty to obtain a systematic anatomical reduction.
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Wang S, Yu X, Li B, Ding Q, Wang T, Li Q, Liu L, Wu H. Pipkin type III femoral head fracture: which treatment strategy can be recommended? J Orthop Traumatol 2023; 24:28. [PMID: 37328665 DOI: 10.1186/s10195-023-00701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 05/01/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Pipkin type III femoral head fractures are relatively rare injuries. Few studies have explored and described the treatment and outcomes of Pipkin type III femoral head fractures. The purpose of this study was to evaluate the efficacy of open reduction and internal fixation (ORIF) in treating Pipkin type III femoral head fractures. METHODS We retrospectively reviewed 12 patients with Pipkin type III femoral head fractures who underwent ORIF from July 2010 and January 2018. The complications and reoperations were recorded. The visual analog scale (VAS) pain score, Harris hip score (HHS), Thompson-Epstein criteria, and SF-12 score [including the physical component summary (PCS) and the mental component summary (MCS)] were used for functional assessment. RESULTS Among the 12 patients, ten were males and two were females, with a mean age of 34.2 ± 11.9 years. The median follow-up time was 6 years (range 4-8 years). Five patients (42%) developed osteonecrosis of the femoral head, and one patient (8%) developed nonunion. These six patients (50%) underwent total hip arthroplasty (THA). One patient (8%) developed heterotopic ossification and underwent ectopic bone excision; this patient also presented with post-traumatic arthritis. The mean final VAS pain score and HHS were 4.1 ± 3.1 points and 62.8 ± 24.4 points, respectively. According to the Thompson-Epstein criteria, there was one patient (8%) with excellent, four patients (33%) with good, one patient (8%) with fair, and six patients (50%) with poor outcomes. The PCS score and MCS score were 41.7 ± 34.7 points and 63.2 ± 14.5 points, respectively. CONCLUSION Limited by the high incidence of osteonecrosis of the femoral head, it is difficult to achieve satisfactory functional outcomes when treating Pipkin type III femoral head fractures using ORIF, and a primary THA may be considered. However, for younger patients, considering the survivorship of prosthesis, ORIF may be recommended with the proviso that the patient is fully informed of the high complication rate associated with this procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Xiaojun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Bohua Li
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qing Ding
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Tianqi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Qin Li
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lei Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, People's Republic of China.
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.
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Shakya S, Chen J, Sun J, Xiang Z. Management and outcome of patients with femoral head fractures: the mid-term follow-up with injuries and associated prognostic factors. BMC Musculoskelet Disord 2023; 24:311. [PMID: 37081472 PMCID: PMC10116746 DOI: 10.1186/s12891-023-06317-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Femoral head fractures are rare injuries often associated with poor functional outcomes and complications. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications, and functional outcomes of femoral head fractures. METHODS We retrospectively reviewed 50 patients who sustained femoral head fractures between January 2011 and December 2018. There were thirty-seven (74%) males and thirteen (26%) females with a median age of 40 years. According to Pipkin's classification, there were eighteen (36%) Pipkin I, ten (20%) Pipkin II, eight (16%) Pipkin III, and fourteen (28%) Pipkin IV patients. Treatment methods were categorized into non-operative, operative by open reduction and internal fixation (ORIF), and immediate total hip replacement (THR). The recorded surgical approach consists of an anterior(S-P) approach, posterior(K-L) approach, lateral stab, and combined anterior + lateral stab approach for fixation. The patients were also stratified by the Injury Severity Score (ISS), associated injuries, and, mechanism of injuries. The modified harris hip score (MHHS) was used to evaluate the ongoing complications with the clinical outcome of patients with two years or greater follow-up. RESULTS Eight (16%) patients were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, and 5 (10%) patients required immediate THR. Six (12%) patients developed AVN, and four (8%) required a secondary THR. Sixteen patients (33%) developed post-traumatic osteoarthritis (PTOA), eight (16%) developed heterotopic ossification (HO) and six patients (12%) had sciatic nerve injury, none requiring operative treatment. Overall functional results according to MHHS were, excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. A statistically significant difference in outcome was observed among four pipkin subtypes. CONCLUSION Femoral head fractures are rare injuries often associated with poor outcomes. In this study, we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on the Pipkin classification. The treatment aim should always be the anatomical reduction of the fragments. This study, adds to the growing literature on femoral head fracture and provides a reference for the clinical treatment to guide patient management. TRIAL REGISTRATION Our study was approved by the Clinical Research and Biomedical Ethical Committee of West China Hospital, Sichuan University, and was performed in accordance with the Declaration of Helsinki. All participants provided written informed consent to participate in this study.
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Affiliation(s)
- Sujan Shakya
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jialei Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Jiachen Sun
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Zhou Xiang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
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Cichos KH, White PA, Bergin PF, Ghanem ES, McGwin G, Hawkins J, Spitler CA. Risk Factors for Early Conversion Total Hip Arthroplasty After Pipkin IV Femoral Head Fracture. J Orthop Trauma 2023; 37:181-188. [PMID: 36730828 DOI: 10.1097/bot.0000000000002512] [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] [Accepted: 10/17/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine risk factors for early conversion total hip arthroplasty (THA) in Pipkin IV femoral head fractures. DESIGN Retrospective cohort. SETTING Two level I trauma centers. PATIENTS AND INTERVENTION One hundred thirty-seven patients with Pipkin IV fractures meeting inclusion criteria with 1 year minimum follow-up managed from 2009 to 2019. MAIN OUTCOME MEASUREMENT Patients were separated into groups by the Orthopaedic Trauma Association/AO Foundation (OTA/AO) classification of femoral head fracture: 31C1 (split-type fractures) and 31C2 (depression-type fractures). Multivariable regression was performed after univariate analysis comparing patients requiring conversion THA with those who did not. RESULTS We identified 65 split-type fractures, 19 (29%) underwent conversion THA within 1 year. Surgical site infection ( P = 0.002), postoperative hip dislocation ( P < 0.0001), and older age ( P = 0.049) resulted in increased rates of conversion THA. However, multivariable analysis did not identify independent risk factors for conversion. There were 72 depression-type fractures, 20 (27.8%) underwent conversion THA within 1 year. Independent risk factors were increased age ( P = 0.01) and posterior femoral head fracture location ( P < 0.01), while infrafoveal femoral head fracture location ( P = 0.03) was protective against conversion THA. CONCLUSION Pipkin IV fractures managed operatively have high overall risk of conversion THA within 1 year (28.5%). Risk factors for conversion THA vary according to fracture subtype. Hip joint survival of fractures subclassified OTA/AO 31C1 likely depends on patient age and postoperative outcomes such as surgical site infection and redislocation. Pipkin IV fractures subclassified to OTA/AO 31C2 type with suprafoveal and posterior head impaction and older age should be counseled of high conversion risk with consideration for alternative management options. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kyle H Cichos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Parker A White
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS; and
| | - Patrick F Bergin
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS; and
| | - Elie S Ghanem
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Gerald McGwin
- Department of Epidemiology, UAB School of Public Health, Birmingham, AL
| | - Jacob Hawkins
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
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Chen CY, Hsu SL, Hsu CH, Liu HC, Lu YD. Pipkin Type I and II femoral head fractures: internal fixation or excision?-from the hip arthroscopy perspective. J Hip Preserv Surg 2023; 10:31-36. [PMID: 37275831 PMCID: PMC10234391 DOI: 10.1093/jhps/hnad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/25/2022] [Accepted: 01/16/2023] [Indexed: 06/07/2023] Open
Abstract
The treatment of patients with femoral head fractures with regard to fixation versus excision is controversial. This study aimed to compare the results of fixation and excision in hip arthroscopy-assisted surgery. This retrospective study included adult patients with femoral head fractures who were treated with hip arthroscopy surgery from March 2016 to April 2020, with a minimum follow-up of 24 months. The patients were divided into two groups: Group 1 (fixation group) and Group 2 (excision group). To compare the therapeutic effects between the two groups, clinical and radiographic outcomes, operative time, pain score, length of hospital stay after surgery and related complications were investigated. There were 13 (mean duration, 47.5 months; range, 24-72 months) and 8 (mean duration, 48.6 months; range, 26-74 months) patients in the fixation and excision groups, respectively. The excision group had better functional results than the fixation group in terms of the median modified Harris hip score (P = 0.009). No significant differences were observed in operative time, pain score or hospital stay after surgery between the two groups. Further, no osteonecrosis of the femoral head or traumatic arthritis occurred in either group. A piece of fracture fragment >2 cm can be considered for hip arthroscopy-assisted internal fixation, whereas the others can be removed. The excision group had better outcomes than the fixation group. Hence, hip arthroscopy-assisted internal fixation or excision of bony fragments led to satisfactory short-term clinical and radiological results for the treatment of Pipkin Type I and II femoral head fractures.
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Affiliation(s)
- Chung-Yang Chen
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No 123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan
| | | | - Chi-Hsiang Hsu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No 123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan
| | - Hao-Chen Liu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No 123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan
| | - Yu-Der Lu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No 123, Dapi Rd., Niaosong Dist., Kaohsiung 83301, Taiwan
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Castano Betancourt MC, Maia CR, Munhoz M, Morais CL, Machado EG. A review of Risk Factors for Post-traumatic hip and knee osteoarthritis following musculoskeletal injuries other than anterior cruciate ligament rupture. Orthop Rev (Pavia) 2022; 14:38747. [DOI: 10.52965/001c.38747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Post-traumatic osteoarthritis (PTOA) is a common form of osteoarthritis that might occur after any joint trauma. Most PTOA publications mainly focus on anterior cruciate ligament (ACL) injuries. However, many other traumatic injuries are associated with PTOA, not only for the knee but also for the hip joint. We aim to identify and summarize the existing literature on the musculoskeletal injuries associated with knee and hip PTOA and their risk factors in determining those with a worse prognosis, excluding ACL injuries. Despite the narrative nature of this review, a systematic search for published studies in the last twenty years regarding the most relevant injuries associated with a higher risk of PTOA and associated risk factors for OA was conducted. This review identified the six more relevant injuries associated with knee or hip PTOA. We describe the incidence, risk factors for the injury and risk factors for PTOA of each. Meniscal injury, proximal tibial fracture, patellar dislocation, acetabular, femoral fractures and hip dislocations are all discussed in this review.
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Chiron P, Reina N. Dislocation fracture of the femoral head in adult. EFORT Open Rev 2022; 7:375-383. [PMID: 35638606 PMCID: PMC9257734 DOI: 10.1530/eor-22-0041] [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] [Indexed: 11/20/2022] Open
Abstract
The smaller the head fragment, the more likely it is located at the bottom and in front of the femoral head, which then determines the most suitable approach. A CT scan is essential after reduction and before resumption of weight-bearing to verify the size and congruence of the fragments and whether there are foreign bodies and/or a fracture of the posterior wall. Classifications should include the size of the fragment and whether or not there is an associated fracture of the acetabulum or femoral neck (historical ‘Pipkin’, modernised ‘Chiron’). In an emergency, the dislocation should be rectified, without completing the fracture (sciatic nerve palsy should be diagnosed before reduction). A hip prosthesis may be indicated (age or associated cervical fracture). Delayed orthopaedic treatment is sufficient if congruence is good. A displaced fragment can be resected (foreign bodies and ¼ head), reduced and osteosynthesised (⅓ and ½ head), and a posterior wall fracture reduced and osteosynthesised. Small fragments can be resected under arthroscopy. The approach is medial (Luddloff, Ferguson, Chiron) to remove or osteosynthesise ⅓ or ¼ fragments; posterior for ½ head or a fractured posterior wall. The results remain quite good in case of resection or an adequately reduced fragment. Long-term osteoarthritis is common (32%) but well tolerated with a low rate of prosthetisation. Avascular necrosis remains a possible complication (8.2%). Sciatic nerve palsy (4% of fracture dislocations) is more common for dislocations associated with posterior wall fractures.
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Affiliation(s)
- Philippe Chiron
- Orthopédie Traumatologie, Secteur A, Batiment riquet, étage 5, CHU Toulouse, Toulouse Cedex 9, France
| | - Nicolas Reina
- Orthopédie Traumatologie, Secteur A, Batiment riquet, étage 5, CHU Toulouse, Toulouse Cedex 9, France
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Lehmann W, Spering C. Pipkin-Frakturen. Unfallchirurg 2022; 125:313-322. [DOI: 10.1007/s00113-022-01153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/24/2022]
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Li QW, Zhou CS, Li YP. Case report of a delayed iatrogenic Pipkin type III femoral head fracture-dislocation. Medicine (Baltimore) 2022; 101:e28773. [PMID: 35089256 PMCID: PMC8797484 DOI: 10.1097/md.0000000000028773] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/19/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pipkin III femoral head fracture dislocation (FHFD) is rarely observed in clinical practice, and its outcome is alarming. A considerable proportion of Pipkin III fractures result from repeated or forceful closed reduction of an irreducible FHFD. Pipkin type III fractures pose a therapeutic challenge. Most patients underwent total hip arthroplasty. PATIENT CONCERNS A 34-year-old man experienced high-energy trauma to the left hip from a terrible traffic accident. Radiography and computed tomography (CT) at the local hospital revealed a left posterior FHFD. Emergency close reduction of the hip was performed.48 hours later, the patient was transferred to our institution. New radiography and CT examinations demonstrated an iatrogenic femoral neck fracture (FNF) associated with FHFD. In addition, a right talar fracture was observed. DIAGNOSIS Pipkin III fracture combined with contralateral talar fracture. INTERVENTIONS Considering his Pipkin fracture classification (Pipkin Type-III) and the time to surgery after his injury (>48 hours), the patient underwent left total hip arthroplasty uneventfully, followed by below-ankle plaster cast immobilization for his right ankle. OUTCOMES At the 6-month follow-up, the patient was able to walk pain-free, and plain radiographs were satisfactory, with no evidence of heterotopic ossification or osteonecrosis of the talus. LESSONS Before emergency closed reduction, early recognition of the unique characteristics of an irreducible FHFD is essential to avoid iatrogenic femoral neck fracture.
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Sen RK, Tripathy SK, Goyal T, Aggarwal S, Kashyap S, Purudappa PP, Chandrappa MH. Complications and Functional Outcome of Femoral Head Fracture-Dislocation In Delayed and Neglected Cases. Indian J Orthop 2021; 55:595-605. [PMID: 33995862 PMCID: PMC8081802 DOI: 10.1007/s43465-020-00309-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/06/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Delayed reduction of the hip in femoral head fracture dislocation increases the risk of osteonecrosis and adversely affects the functional outcome. MATERIALS AND METHODS This retrospective study was designed to evaluate the outcome and complications of 138 patients with femoral head fracture dislocation treated by a single surgeon over a period of 22 years. Only seven patients presented within 24 h of injury and remaining all presented late. The hip joints could be reduced by closed manoeuvre in 105 patients, and 33 patients needed open reduction. The patients were managed conservatively or surgically. The mean follow-up period was 3.57 years (1-18 years). RESULTS There were 119 males and 19 females. The mean age was 35.71 years (range, 18-70 years). Forty-two patients were managed conservatively, and 96 patients needed surgical treatment. The Kocher-Langenbeck approach was used in 40 patients, the trochanteric flip osteotomy in 14 patients, the Smith-Peterson approach in 31 patients, and the Watson-Jones approach in one patient. The femoral head fragment was fixed in 47.82% patients and excised in 11.59% patients. Primary total hip replacement (THR) was performed in 7.24% of patients through the posterior approach. 24.63% of patients developed complications with 14.49% of hip osteonecrosis, 2.89% posttraumatic osteoarthritis and 2.17% femoral head resorption. 55% of patients who developed osteonecrosis were operated through the posterior approach. Secondary procedures were needed in 14.48% of patients. The clinical outcome, as evaluated using the modified Harris Hip Score, was good to excellent in 52.89% of patients and poor to fair in 47.11% of patients. CONCLUSION The incidences of osteonecrosis and secondary procedures are increased in delayed and neglected femoral head fracture dislocation. Osteonecrosis is commonly seen in Brumback 2A injuries and posterior-based approaches. All Brumback 3B fractures in such delayed cases should be treated with THR. Osteosynthesis or conservative treatment should be reserved for other types of injuries. A careful selection of treatment plan in such delayed cases can result in a comparable functional outcome as reported in the literature.
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Affiliation(s)
- Ramesh Kumar Sen
- grid.429234.a0000 0004 1792 2175Orthopaedics Unit, Max Hospital, Mohali, Chandigarh India
| | - Sujit Kumar Tripathy
- grid.413618.90000 0004 1767 6103Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019 India
| | - Tarun Goyal
- grid.413618.90000 0004 1767 6103Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, India
| | - Sameer Aggarwal
- grid.415131.30000 0004 1767 2903Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Kashyap
- grid.414489.40000 0004 1768 2079Deptartment of Orthopedics, Indira Gandhi Medical College, Shimla, India
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Articular Femoral Head Fracture Management: A Meta-analysis of Literature. Indian J Orthop 2021; 55:304-313. [PMID: 34306543 PMCID: PMC8275725 DOI: 10.1007/s43465-021-00431-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/20/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Articular fractures of the proximal femur are seldom encountered and there are few studies in literature regarding this topic. To date, only a few large series have adequate follow-up and exhaustive description of treatment and outcome, which, however, often result incomplete and do not allow a comparison. Since there are still uncertainties and debates on which the treatment gold standard should be, the goal of the present study is to carry out a meta-analysis on type I and II Pipkin fracture management to establish the best treatment according to EBM. METHODS Studies regarding acetabular fractures of the femur head were identified from Google Scholar, Cochrane Library, Medline, ScienceDirect and PubMed; gray studies were searched from the included references' literature, and using general search engines and Social media; the query to be temporally extended from 1996 to 2020. Only comparative studies were included; we ruled out case-reports, case series, author's opinion, register databases. RESULTS Comparing conservative and surgical treatment, we found evidence of a better outcome choosing surgical treatment. We found a significant better outcome with open reduction internal fixation, instead of fragment excision. Comparing failure rate of surgical approaches, we found no statistically significant difference. CONCLUSION Our study proves that there is evidence in favor of operative treatment rather than conservative in complete or displaced Pipkin fracture Type I + II; open reduction internal fixation should be preferred rather than fragment excision, whenever possible. LEVEL OF EVIDENCE III. Therapeutic.
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Comparison of Fragment Removal Versus Internal Fixation for Treatment of Pipkin I Femoral Head Fractures: A Finite Element Analysis. Int Surg 2020. [DOI: 10.9738/intsurg-d-16-00039r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fragment removal and internal fixation are the principle treatments for Pipkin type I femoral head fractures. The aim of this study was to compare, using a finite-element method, changes in stress on the femoral head after 2 different operation types. A three-dimensional (3D) finite-element model of a Pipkin type I femoral head fracture was generated with MIMICS and ABAQUS software. A 3D numerical screw model was reconstructed based on data from BIOFIX and using SOLIDWORKS software. The screw was implanted in the fragment and femoral head to reconstruct the implantation. Stress changes on the femoral head after removal of the fragment and internal fixation were investigated. Mean stresses along 13 points were 16.94 ± 16.79 MPa in the fragment removal group and 14.17 ± 14.08 MPa in the internal fixation group (P < 0.05). Random tests indicated that the mean stresses along 50 randomly determined points were 25.41 ± 12.12 MPa in the fragment removal group and 19.45 ± 14.62 MPa in the internal fixation group (P < 0.05). Compared with internal fixation, fragment removal led to greater stress that was more concentrated in the femoral head.
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Rana R, Verma D, Behera S, Behera H, Raulo B. Irreducible Femur Head Fracture-Dislocation Treatment With Kocher-Langenbeck Approach With Flip Trochanteric Osteotomy: A Novel Approach. Cureus 2020; 12:e11969. [PMID: 33425543 PMCID: PMC7788007 DOI: 10.7759/cureus.11969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Femoral head fracture-dislocations are rare, and irreducible cases are even less frequent. Truly irreducible fracture-dislocations must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. The Pipkin classification is commonly used to classify femoral head fractures. An urgent reduction is required in traumatic hip dislocations to reduce the risk of avascular necrosis (AVN) of the femoral head. However, in femoral head fractures, the dislocated hip cannot be reduced easily due to incarcerated bone or soft tissue. In an irreducible fracture hip dislocation, It is not advisable to attempt to reduce it repeatedly because sometimes femoral head fracture-dislocation is associated with the impacted fracture of the femoral neck. It may lead to iatrogenic femoral neck fracture. Hence, in such cases, immediate open reduction and internal fixation are recommended. The Kocher-Langenbeck approach can be used for reduction and safe surgical dislocation with flip trochanteric osteotomy for fixation as a novel approach.
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Affiliation(s)
- Rajesh Rana
- Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND.,Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Deepak Verma
- Orthopedics and Traumatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Sudarsan Behera
- Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND.,Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Himansu Behera
- Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Binod Raulo
- Orthopedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
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Pipkin type IV femoral head fractures: a case series and review of literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:791-795. [PMID: 33211232 DOI: 10.1007/s00590-020-02838-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Femoral head fractures with associated acetabular fractures are uncommon injuries usually resulting from high-energy mechanisms such as motor vehicle collisions. Outcomes of Pipkin type IV fractures have been historically poor, with high rates of osteonecrosis, post-traumatic arthritis, and heterotopic ossification. The objective of this study was to define the outcomes of operatively treated Pipkin type IV fractures In addition, we reviewed the available literature of this uncommon injury pattern. METHODS A retrospective chart review at a single level 1 trauma center from 2007 to 2016 identified 10 patients with Pipkin IV femoral head fractures. Demographic information, fracture type, associated injuries, operative details, and complications were evaluated. Clinical and radiological outcomes were assessed at latest follow-up including conversion to total hip arthroplasty. RESULTS Six of the seven patients were treated with open reduction and internal fixation of the femoral head fracture and acetabular fracture through a Kocher-Langenbeck approach aided by a trochanteric flip and one had fragment excision. Six patients (87.5%) developed post-traumatic arthritis. Four (57.1%) later underwent conversion to total hip arthroplasty (THA) a mean of 20.5 months after index procedure. CONCLUSION Our study shows a rate of osteonecrosis and osteoarthritis that is even higher than the previously reported studies. The former may relate to longer-term follow-up and the latter possibly due to associated comminuted posterior wall fracture.
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Chen W, Gao Z, Ma L. Failed reduction of posterior hip dislocation accompanied by femoral head fracture: causes and resolving strategy. INTERNATIONAL ORTHOPAEDICS 2020; 45:1609-1614. [PMID: 33108471 DOI: 10.1007/s00264-020-04856-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND We investigated the causes of failure of the Allis manoeuvre for posterior hip dislocations with an associated Pipkin type I femoral head fractures. The effectiveness of a modified Allis manoeuvre was also evaluated. METHODS From January 2013 to December 2016, we enrolled five patients with a posterior hip dislocation associated by a Pipkin type I femoral head fracture who were treated initially with the Allis manoeuvre that subsequently failed. Radiographic evaluations were performed to determine the cause of failure, and then a modified Allis manoeuvre was performed. During this procedure, the hip and knee joints of the injured lower limb were both flexed to 90°, and the leg was pulled posteriorly following an upward force to reduce the dislocation. Reduction was assessed by radiographic evaluation. RESULTS In all patients, the fractured femoral head was incarcerated on the superior edge of the posterior rim of the acetabulum, resulting in failure of the conventional Allis manoeuvre. Satisfactory reduction was achieved with a modified Allis manoeuvre. The mean follow-up duration was 31 months. The femoral head fracture healed after four months on average. The mean Harris score was 91 at the final follow-up. Re-dislocation or femoral head necrosis was not observed. CONCLUSIONS For posterior hip dislocations associated with a Pipkin type I femoral head fracture, failed reduction is often caused by incarceration of the fractured femoral head on the superior edge of the posterior rim of the acetabulum. The modified Allis manoeuvre can effectively reduce the combined injury in a closed fashion.
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Affiliation(s)
- Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Ze Gao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Lijie Ma
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, 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: 3.0] [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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Tripathy SK, Das SS, Rana R, Jain M. Trochanteric osteotomy for safe surgical approach to bilateral hip dislocations with femoral head fractures. J Clin Orthop Trauma 2020; 11:S530-S533. [PMID: 32774024 PMCID: PMC7394790 DOI: 10.1016/j.jcot.2020.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
A 23-year old male with bilateral hip dislocations and associated femur head fractures (Pipkin type-II) presented with pain and flexion deformity of both hips after 9 days. After imaging, closed reduction was attempted but failed. Open reduction through Kocher-Langenbeck approach was performed and the femoral head fracture was accessed through Ganz's safe surgical dislocation. The fracture was reduced anatomically and fixed with headless Herbert screws. After two years, the patient was walking without pain or limp and there was no evidence of osteonecrosis. Simultaneous sequential Ganz's safe surgical dislocation can be performed in bilateral Pipkin's fracture dislocation with excellent short term outcome.
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Affiliation(s)
- Sujit Kumar Tripathy
- Corresponding author. author: Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubanewar, 751019, India.
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Fernandez M, Williams T, Dubrana F, Di Francia R. A rare case of an irreducible Pipkin II fracture–dislocation of the femoral head in a young patient following low-energy trauma. Int J Surg Case Rep 2020; 70:234-237. [PMID: 32422586 PMCID: PMC7231814 DOI: 10.1016/j.ijscr.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/29/2020] [Accepted: 04/09/2020] [Indexed: 12/01/2022] Open
Abstract
A rare presentation of hip fracture-dislocation: irreducible. Very unusual consequence of a low energy trauma mechanism. Damage appeared unusually in a young patient without known bone abnormalities. Controversial first line total hip replacement treatment.
Introduction Fractures–dislocations of the femoral head are rare, and irreducible dislocations are even rarer. The functional prognosis is poor. Presentation of case We report the case of a 23-year-old male brought to the emergency room following low-energy trauma. X-rays and a computed tomography scan revealed a Pipkin II fracture–dislocation of the right femoral head. We attempted reduction with the patient under general anesthesia; this failed, so we proceeded to total hip arthroplasty (THA). Discussion A femoral head fracture has a poor prognosis; the principal complications are osteonecrosis, osteoarthritis, and heterotopic ossifications. No surgical treatment algorithm for a femoral head fracture (for fragment excision, followed by internal fixation or THA) is available, given the rarity of the injury and the lack of sufficient cases. Conclusions We describe the mechanism of low-energy injury, as well as the controversial THA treatment chosen by this young patient.
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Affiliation(s)
- Marie Fernandez
- Service de Traumatologie, CHRU Cavale Blanche, Brest, France
| | - Thomas Williams
- Service de Traumatologie, CHRU Cavale Blanche, Brest, France
| | | | - Rémi Di Francia
- Service de Traumatologie, CHRU Cavale Blanche, Brest, France.
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Traumatic hip fracture-dislocation: A middle-term follow up study and a proposal of new classification system of hip joint associated injury. Injury 2019; 50 Suppl 4:S11-S20. [PMID: 30683569 DOI: 10.1016/j.injury.2019.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/13/2018] [Accepted: 01/12/2019] [Indexed: 02/08/2023]
Abstract
Traumatic hip fracture dislocation is a rare injury associated with high-energy trauma. Most of these injuries should be surgically treated. Hip dislocation is an orthopaedic emergency and reduction must be performed within 6-8 hours of trauma. We performed a retrospective analysis of 69 patients with "hip joint associated injuries", treated between January 2002 and December 2016. 33 patients were assessed at a mean follow-up of 36.9 months (range 18-132) after surgery. We propose a new classification system in which, different patterns of fracture (head and/or neck and/or acetabular) are described according to different types of hip dislocation. This anatomical-descriptive classification system is based on the concept of hip as a complex anatomical district and contains all possible traumatic injuries associated with hip dislocation. It includes isolated hip dislocation, hip dislocation with femoral head or neck fracture or hip dislocation with acetabular fracture and femoral head fracture. There are 4 groups: Each one of the previous groups is composed by different subgroups. Post-traumatic osteoarthritis is the most common complication of these hip injuries, followed by avascular necrosis of femoral head and heterotopic ossification. The bad prognosis depends on the type of trauma rather than surgical treatment.
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Bilateral posterior hip dislocation associated with right Pipkin II fracture: A case report. Int J Surg Case Rep 2019; 61:103-106. [PMID: 31352316 PMCID: PMC6664009 DOI: 10.1016/j.ijscr.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bilateral posterior hip dislocations are very rare injury, requiring a very hight trauma energy. PRESENTATION OF THE CASE We present a case of 40-year-old male who sustained bilateral posterior hip dislocation with associated right femoral head fracture Pipkin type II following a hight energy trauma without neurovascular deficit. A prompt closed reduction was made, it was successful in lift hip but incomplete in right one, therefore, an open reduction was indicated, performed through a modified Hardinge approach permitting internal osteosynthesis with two Herbert screws. DISCUSSION Posterior hip dislocations are an orthopaedic emergency that must be reduced within 6 h to avoid sciatic nerve compression and avascular necrosis (AVN). They are most often associated with femoral head fractures commonly known as Pipkin's fractures, that need anatomic reduction and osteosynthesis through posterior approaches, rarely external or anterior approaches. RESULTS Anatomic and functional results were good at two years follow up excepting a right hip non-bridging heterotopic ossification; the patient returned to his work normally without any functional sequelae.
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Poletti PA, Sahin M, Peter R, Boudabbous S, Herpe G, Rutschmann OT, Platon A. Femoral head subchondral impaction on CT: what does it mean in patients with acetabular fracture? Skeletal Radiol 2019; 48:939-948. [PMID: 30393834 DOI: 10.1007/s00256-018-3100-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the prevalence of isolated femoral head impactions associated with acetabular fractures and to assess whether impactions may be predictive of the development of delayed major complications requiring total hip arthroplasty. MATERIALS AND METHODS A total of 128 consecutive adult patients with acetabular fracture and no femoral head fracture were included. Admission CTs were re-interpreted for the presence of hip dislocation and femoral head impactions. Radiological and clinical reports were reviewed in patients in whom conservative management of the femoral head was attempted, to determine if total hip arthroplasty was eventually required over a 48-month follow-up period. Univariate and multivariate analyses were performed to assess whether impaction is an independent predictor of failure of conservative management. RESULTS Impaction was found in 40% of all patients (51 out of 128), in 58% of those with dislocation (19 out of 33), and in 34% of those without dislocation (32 out of 95; p < 0.05). One hundred and five patients underwent conservative management of the femoral head; 12.5% of them (13 out of 105) eventually required total hip arthroplasty. An impaction was present in 77% of the latter (10 out of 13) and in 33% of patients with successful conservative management (30 out of 92; p = 0.0042). At multivariate analysis, impaction and dislocation were significantly and independently associated with a higher risk for delayed total hip arthroplasty (odds ratio of 4.8 and 4.0 respectively). CONCLUSION Femoral head impactions are frequently seen on CT of patients with acetabular fractures; they are independent predictive factors for the need for delayed total hip arthroplasty. They should be systematically mentioned in the CT report.
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Affiliation(s)
- Pierre-Alexandre Poletti
- Emergency Radiology Unit, Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
| | - Mehmet Sahin
- Emergency Radiology Unit, Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Robin Peter
- Department of Orthopaedic Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- Musculoskeletal Radiology Unit, Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - Guillaume Herpe
- Emergency Radiology Unit, Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Olivier T Rutschmann
- Department of Community, Primary Care, and Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Alexandra Platon
- Emergency Radiology Unit, Department of Radiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
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Keong MW, Razak HRBA, Koon WM, Ping CC. Case Report of a Rare Pipkin Type III Femoral Head Fracture. J Orthop Case Rep 2019; 9:11-15. [PMID: 32547994 PMCID: PMC7276619 DOI: 10.13107/jocr.2019.v09.i05.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Femoral head fractures are rare injury compared to other hip pathologies and often associated with posterior hip dislocation. Such fractures are often fraught with complications even after successful surgical fixation. Pipkin described a classification system for such fractures, dividing them into four types, of which Type III (31C.3) fractures are associated with femoral neck fractures. These fractures are the least common and often associated with the worst outcomes. Case Report We report a rare case of Pipkin Type III fracture after attempted hip relocation and review literature on this topic. A 35-year-old female sustained a right posterior hip dislocation with femoral head fracture following a fall. After attempts of manipulation and reduction, she sustained an iatrogenic right femoral neck fracture resulting in a Pipkin III femoral head fracture. Open reduction and reduction of fracture achieved through headless compression screw of femoral head and cortical screws of femoral neck. Four months after surgery, the patient under osteonecrosis of the femoral head and subsequently required conversion to a right total hip arthroplasty. Conclusion Femoral head fractures have serious sequelae and should be treated with caution. A high index of suspicion is required; hence, if clinically suspicious, proper imaging is paramount to prevent iatrogenic injury to the femoral neck resulting in subsequent avascular necrosis.
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Affiliation(s)
- Mak Wai Keong
- Department of Orthopaedics, Sengkang General Hospital, 110 Sengkang East Way, Singapore
| | | | - Wong Merng Koon
- Department of Orthopaedics, Sengkang General Hospital, 110 Sengkang East Way, Singapore
| | - Chew Chee Ping
- Department of Orthopaedics, Sengkang General Hospital, 110 Sengkang East Way, Singapore
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Del Core MA, Gross B, Ahn J, Wallace SB, Starr A. Clinical and Radiographic Outcomes of Femoral Head Fractures Associated with Traumatic Hip Dislocations. Strategies Trauma Limb Reconstr 2019; 14:6-10. [PMID: 32559260 PMCID: PMC7001600 DOI: 10.5005/jp-journals-10080-1416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Femoral head fractures are an uncommon but severe injury. These high-energy injuries typically occur in association with traumatic hip dislocations. Initial treatment includes urgent concentric reduction; however, controversy exists regarding specific fracture management. The well-known complications of avascular necrosis (AVN), posttraumatic arthritis (PTA), and heterotrophic ossification can leave patients with a significant functional loss of their affected hip. The purpose of this study is to evaluate the clinical and radiographic outcomes of femoral head fractures. Methods A retrospective review was performed at our institution assessing all patients who presented from 2007 to 2015 with a femoral head fracture associated with a hip dislocation and at least 6 months of clinical and radiographic follow-up. Twenty-two patients met our inclusion criteria. There were 15 males and 7 females with an average age of 36 years (range: 17-55). The average follow-up time was 18 months (range: 6-102). Fractures were classified according to the Pipkin classification. The Thompson and Epstein score was used to determine functional outcomes. Results There were five, Pipkin I, 3 Pipkin II, 0 Pipkin III, and 14 Pipkin IV, femoral head fractures. Sixteen patients were successfully closed reduced in the emergency department (ED) and six patients required open reduction after failed reduction in the ED. Four patients (18%) were successfully treated with closed reduction alone and 18 patients (82%) required operative intervention. Of those undergoing operative intervention, one patient underwent excision of the femoral head fragment, seven underwent open reduction internal fixation (ORIF) of the femoral head, nine underwent ORIF of the acetabulum, and one underwent ORIF of the femoral head and the acetabulum. Nine patients (41%) had an uneventful postoperative course. Two patients (9%) developed AVN, both requiring total hip arthroplasty (THA). Five patients (23%) developed PTA, two eventually requiring a THA. Two patients (9%) had sciatic nerve palsy. One patient (5%) developed a postoperative infection and four patients (18%) developed heterotrophic ossification (HO), none requiring operative treatment. Two patients (9%) had persistent anterolateral (AL) thigh numbness. Overall functional results were excellent in six patients (27%), good in six (27%), fair in seven (32%), and poor in three patients (14%). Four patients (18%) required a THA. Conclusion Femoral head fractures are a rare injury with well-known complications. Early diagnosis and concentric reduction are the prerequisites for successful treatment. This study adds to the growing literature on femoral head fractures associated with hip dislocations in efforts to define treatment plans and to guide patient expectations. How to cite this article Del Core MA, Gross B, Ahn J, et al. Clinical and Radiographic Outcomes of Femoral Head Fractures Associated with Traumatic Hip Dislocations. Strategies Trauma Limb Reconstr 2019;14(1):6-10.
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Affiliation(s)
- Michael A Del Core
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Bruno Gross
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Junho Ahn
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Stephen Blake Wallace
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Adam Starr
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
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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: 0.6] [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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Tosounidis T, Aderinto J, Giannoudis PV. Pipkin Type-III fractures of the femoral head: Fix it or replace it? Injury 2017; 48:2375-2378. [PMID: 29061440 DOI: 10.1016/j.injury.2017.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Theodoros Tosounidis
- Academic Department of Trauma and Orthopaedics, Floor D, Clarendon Wing, LGI, University of Leeds, Leeds, UK
| | - Joseph Aderinto
- Academic Department of Trauma and Orthopaedics, Floor D, Clarendon Wing, LGI, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, Floor D, Clarendon Wing, LGI, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK.
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Yu X, Pang QJ, Chen XJ. Clinical results of femoral head fracture-dislocation treated according to the Pipkin classification. Pak J Med Sci 2017; 33:650-653. [PMID: 28811788 PMCID: PMC5510120 DOI: 10.12669/pjms.333.12633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To summarize the clinical results of femoral head fracture-dislocation treated according to Pipkin classification. Methods: Atotal of 19 patients with femoral head fracture-dislocation were retrospectively analyzed from Mar. 2008 to Mar. 2015. According to the classification of Pipkin criteria, there were 4 cases in Type-I, 6 cases in Type-II, 6 cases in Type-IIIand 3 cases in Type-IV. Various procedures were taken according to the different types of the fracture, the time of the fracture, and the age of the patients. X-ray was examined during the follow-up period and functional evaluation was carried out by Harris Hip Score’s criteria. The clinical therapeutic effects were analyzed. Results: All the patientsgot a mean follow-up of 18 months (9-36 months). No patient suffered from infection, skin flap necrosis and X-ray showed no implants loosening or breakage. According to the Harris Hip Score’s criteria, in Type-I, 4 cases were rated as excellent. In Type-II, 2 cases rated as excellent, 3 cases as good and 1 case as fair. In Type-III, 3 cases rated as good, 2 cases as fair and 1 case as poor. In Type-IV, 1 case rated as excellent, 1 case as good and 1 case as fair. The overall rate of excellent and good was 73.7%. Conclusions: Pipkin classification is helpful to make preoperative plan and judging the prognosis in cases of femoral head fracture-dislocation. However, multiple factors such as the time from injury to surgery, the ages of patients, the selection of implants should also be considered, which may affect the clinical results.
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Affiliation(s)
- Xiao Yu
- Dr. Xiao Yu, PhD. Department of Orthopedics, Ningbo No.2 Hospital, Ningbo, 315010, Zhejiang, China
| | - Qing-Jiang Pang
- Dr. Qing-Jiang Pang, PhD. Department of Orthopedics, Ningbo No.2 Hospital, Ningbo, 315010, Zhejiang, China
| | - Xian-Jun Chen
- Dr. Xian-Jun Chen, MD. Department of Orthopedics, Ningbo No.2 Hospital, Ningbo, 315010, Zhejiang, China
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Abstract
Background
Femoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center. Materials and methods A retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis. Results We identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision. Conclusions Fractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon. Level of evidence IV—prognostic.
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Miyamoto S, Nakamura J, Iida S, Suzuki C, Ohtori S, Orita S, Takahashi K. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases. Case Rep Orthop 2016; 2016:1450842. [PMID: 27293934 PMCID: PMC4884837 DOI: 10.1155/2016/1450842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Abstract
Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga.
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Affiliation(s)
- Shuichi Miyamoto
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
| | - Junichi Nakamura
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
| | - Satoshi Iida
- Matudo City Hospital, 4005 Kamihongou, Matudo City, Chiba 271-8511, Japan
| | - Chiho Suzuki
- Matudo City Hospital, 4005 Kamihongou, Matudo City, Chiba 271-8511, Japan
| | - Seiji Ohtori
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
| | - Sumihisa Orita
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
| | - Kazuhisa Takahashi
- Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8677, Japan
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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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Iida K, Hamai S, Yamamoto T, Nakashima Y, Motomura G, Ohishi M, Karasuyama K, Iwamoto Y. Subchondral fracture of the femoral head after acetabular fracture: a case report. J Med Case Rep 2014; 8:447. [PMID: 25522666 PMCID: PMC4301452 DOI: 10.1186/1752-1947-8-447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 10/30/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Preventing post-traumatic osteoarthritis is a challenging problem following acetabular fracture. Progressive osteoarthritis is considered to be caused by an irregular articular surface of the acetabular roof or cartilage injury, but little is known about the pathogenesis of collapse of the femoral head after acetabular fracture. We report a case of post-traumatic osteoarthritis after acetabular fracture in which subchondral fracture of the femoral head contributed to the progressive collapse of the femoral head and osteoarthritis. To the best of our knowledge, there has been no previous report of subchondral fracture of the femoral head after acetabular fracture. CASE PRESENTATION A 58-year-old Japanese man fell from a ladder. He was diagnosed with a left acetabular fracture, which was managed conservatively. He developed left coxalgia six months after injury and was seen at our institution one year after the onset of pain. The left acetabular fracture had fused, but his left femoral head had collapsed. The images at the time of injury showed a fracture of the acetabular roof, and an approximately 2mm step-off existed in the articular surface. Retrospective evaluation of the plain radiographs and computed tomography images showed that his femoral head had progressively collapsed. Our patient underwent total hip arthroplasty. Histopathologic findings demonstrated that the collapse of his femoral head was caused by a subchondral fracture of his femoral head. CONCLUSION Our experience with this case indicates that in addition to post-traumatic osteonecrosis, subchondral fracture may need to be considered in cases with progressive collapse of the femoral head after acetabular fracture.
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Affiliation(s)
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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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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Acetabular fracture: long-term follow-up and factors associated with secondary implantation of total hip arthroplasty. Orthop Traumatol Surg Res 2013; 99:281-90. [PMID: 23562708 DOI: 10.1016/j.otsr.2012.12.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 09/03/2012] [Accepted: 12/10/2012] [Indexed: 02/02/2023]
Abstract
HYPOTHESIS The present study sought to determine long-term outcome in acetabular fracture and the factors associated with secondary implantation of a total hip arthroplasty and/or with poor functional results. MATERIAL AND METHODS Seventy-two patients admitted between 2000 and 2005 were followed up for a maximum 11 years (mean, 6.8 years): 16 females, 56 males; mean age at injury, 41.6 years (median, 40 years). There were 45 simple acetabular fractures, 27 complex fractures and 27 dislocations. Late complications were: osteoarthritis (n=29), osteonecrosis of the femoral head (ONFH: n=8) and heterotopic ossification (n=2). RESULTS AND DISCUSSION Twenty-five total hip arthroplasties (THA) were performed, with a mean time to surgery of 3.7 years. Associated factors for THA were: VAS (P<0.0001), PMA (P<0.0001), osteoarthritis (P<0.0001), ONFH (P<0.0002), initial dislocation (P=0.0002), no functional treatment (P=0.0014), surgical treatment (P=0.0065), initial traction (P=0.0068), anterior and posterior congruency defect (P=0.0072 and P<0.0001), and initial intra-articular foreign body (P=0.045). Factors associated with poor or bad functional results were the same, plus: etiology (P=0.0021), BMI (P=0.03) and posterior wall fracture (P=0.0325). LEVEL OF EVIDENCE 4; retrospective study.
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Chiron P, Lafontan V, Reina N. Fracture-dislocations of the femoral head. Orthop Traumatol Surg Res 2013; 99:S53-66. [PMID: 23357042 DOI: 10.1016/j.otsr.2012.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 11/23/2012] [Indexed: 02/02/2023]
Abstract
This review describes bone and nerve injury mechanisms during a femoral head fracture-dislocation and outlines a novel classification system that uses computed tomography scanning (CT scan) to help determine how to best treat these fractures in an emergency setting or in chronic cases. A series of 55 cases with CT scan performed in the emergency department (ED) and an average follow-up of 9 years (range 3-13) was used as a basis to develop the classification system; this system takes into account the size of the fragments and any associated acetabular wall or femoral neck fractures. The suggested course of action is based on the CT scan results after the hip joint is reduced. Conservative treatment is indicated every time the head fragments and any potential acetabular wall fragments are properly reduced and there are no foreign bodies (37.7%). Osteochondral head fragments below the fovea must be removed (36.3%). Fragments that are one-third or one-quarter of the head size can either be removed (7.2%) or reduced and fixed (5.4%). A novel medial approach is described that provides minimally invasive access to the anterior-inferior part of the femoral head, which should extend the indications for preservation of one-third head fragments. If the femoral neck is also fractured or a one-half head fragment exists in elderly patients, a total hip replacement should be considered right way (9%). At the latest follow-up, osteoarthritis was present in 43.7% of cases, but was mostly well tolerated - 94% of patients had a WOMAC score between 80 and 100 with signs of osteoarthritis visible on radiographs. Paradoxically, avascular necrosis (9%) is due to small head fractures. The results of our series are compared with the few series that have been published since CT scanning has been systematically used in the ED.
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Affiliation(s)
- P Chiron
- Orthopaedics and Trauma Surgery, Rangueil University Hospital Centre, 1, avenue J.-Poulhès, Toulouse cedex 09, France.
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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: 0.8] [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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