Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin type Ⅱ in the youth / 中华创伤骨科杂志

Objective To evaluate Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin type Ⅱ in the youth.Methods A retrospective analysis was conducted of the 16 patients who had been treated at Department of Orthopaedics,Union Hospital,Tongji Medical College for femoral head fractures of Pipkin type Ⅱ from August 2016 to June 2018.They were 9 men and 7 women,aged from 18 to 45 years (mean,25.6 years).Of them,10 cases who had been complicated with posterior dislocation of the hip received emergency hip reduction(＜ 6 h) before surgical fixation.All the patients underwent Herbert screwing directly via the anterior approach.Their incision length,operation time,intraoperative blood loss,hospitalization time,Harris hip scores,therapeutic efficacy and complications were recorded.Results In this series,the incision length averaged 10.4 cm,operation time 45.6 min,intraoperative blood loss 46.5 mL,and hospitalization time 4.0 d.All the 16 patients were followed up for 11 to 15 months (average,12.7 months).Their Harris hip scores at preoperation,3,6 and 9 months postoperation and at the last follow-up were,respectively,14.3 ±2.2,64.8 ±2.4,81.1 ±4.9,88.1 ±4.6 and 91.9 ± 3.4 points,showing a significant difference between any 2 time points (P ＜ 0.05).The therapeutic efficacy at the last follow-up by the Thompson-Epstein clinical evaluation was assessed as excellent in 9 cases,as good in 6 and as fair in one.No osteonecrosis of the femoral head or heterotopic ossification was observed by follow-up.Conclusion For young patients with femoral head fracture of Pipkin type Ⅱ,Herbert screwing directly via the anterior approach provides easy exposure and manipulation,does not aggravate the blood supply to the femoral head,decreases incidence of heterotopic ossification,and leads to shorter operation time and quick functional recovery of the hip.

Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin type Ⅱ in the youth / 中华创伤骨科杂志

Objective@#To evaluate Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin type Ⅱ in the youth.@*Methods@#A retrospective analysis was conducted of the 16 patients who had been treated at Department of Orthopaedics, Union Hospital, Tongji Medical College for femoral head fractures of Pipkin type Ⅱ from August 2016 to June 2018. They were 9 men and 7 women, aged from 18 to 45 years (mean, 25.6 years). Of them, 10 cases who had been complicated with posterior dis-location of the hip received emergency hip reduction(<6 h) before surgical fixation. All the patients underwent Herbert screwing directly via the anterior approach. Their incision length, operation time, intraoperative blood loss, hospitalization time, Harris hip scores, therapeutic efficacy and complications were recorded.@*Results@#In this series, the incision length averaged 10.4 cm, operation time 45.6 min, intraoperative blood loss 46.5 mL, and hospitalization time 4.0 d. All the 16 patients were followed up for 11 to 15 months (average, 12.7 months). Their Harris hip scores at preoperation, 3, 6 and 9 months postoperation and at the last follow-up were, respectively, 14.3±2.2, 64.8±2.4, 81.1±4.9, 88.1±4.6 and 91.9±3.4 points, showing a significant difference between any 2 time points (P<0.05). The therapeutic efficacy at the last follow-up by the Thompson-Epstein clinical evaluation was assessed as excellent in 9 cases, as good in 6 and as fair in one. No osteonecrosis of the femoral head or heterotopic ossification was observed by follow-up.@*Conclusion@#For young patients with femoral head fracture of Pipkin type Ⅱ, Herbert screwing directly via the anterior approach provides easy exposure and manipulation, does not aggravate the blood supply to the femoral head, decreases incidence of heterotopic ossification, and leads to shorter operation time and quick functional recovery of the hip.

Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice.</p><p><b>METHODS</b>From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20-65 years). The causes of the fractures included traffic accidents (13 cases), falls from a height (four cases), heavy lifting injuries (three cases), and sport injury (one case). All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction.</p><p><b>RESULTS</b>The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36-76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%.</p><p><b>CONCLUSION</b>The mid-term curative effects of a reconstruction plate and bioabsorbable screws in the treatment of Pipkin type IV femoral head fractures is significant, and such the treatment can significantly improve the patient's joint function and quality of life.</p>

Prosthesis selection and complication treatment in elderly femoral neck fractures / 中国组织工程研究

BACKGROUND:Elderly patients with femoral neck fractures have poor regulatory mechanism, accompanied by a variety of comorbidities and complications, so the treatment and rehabilitation of perioperative femoral neck fracture is very important. OBJECTIVE:To review the prosthesis selection and complication treatment in perioperative femoral neck fracture in elderly patients. METHODS:A computer-based research was conducted in PubMed database and CNKI database for the articles published since 2000, the key words were“elderly, femoral neck fracture, perioperative, treatment and rehabilitation, hip fracture”in Chinese and English. The clinical researches were selected. The subjects were the femoral neck fracture patients with the age over 65 years. The review literatures and the literatures with smal cases and old were eliminated, and final y 20 literatures were included for analysis. RESULTS AND CONCLUSION:Due to the osteoporosis of the elderly patients, the internal fixation often failed. For the Garden Ⅲ and Ⅳ femoral neck fracture patients with the age over 65 years, as long as there is no clear contraindication for surgery, the hip replacement is often used for the treatment. The tolerance of the patients should be accurately evaluated before replacement, and the blood pressure, blood glucose and various medical complications should be control ed;the rehabilitation training after replacement is also essential. The common complications in elderly patients after replacement include stress ulcer, deep venous thrombosis, neuropsychiatric symptoms, urinary tract infections and the surgical infection.

Fracturas de la cabeza femoral: ¿corresponden a lesiones catastróficasde la cadera? / Femoral head fractures: are they catastrophic hip injuries?

Objective: To describe the clinical results and complications of patients with femoral head fractures using the Pipkin classification. Materials and Methods: Retrospective and descriptive study. We analyzed the cases of femoral head fractures treated between 1992 and 2008. Medical history of hip surgery, associated injuries, Pipkin classification, type of treatment and complications were recorded from patients medical history. Results: We report 18 cases of femoral head fractures with clinical follow-up averaged 10.3 years (range from 2.3 to 18.7 years). 14 (78 percent) males with a mean age of 44.8 years without previous history of hip disease. In 17 (95 percent) patients the mechanism of injury was a traffic accident. Associated with posterior dislocation in 17 (94 percent) and anterior dislocation in 1 (6 percent) patient. 13 cases required closed reduction, 4 open reduction and in one case primary total hip arthroplasty was performed because of associated cervical hip fracture. There were 5 (28 percent) fractures Pipkin I, 4 (22 percent) Pipkin II, 1 (6 percent) Pipkin III and 8 (44 percent) Pipkin IV. Within the overall complication rates in our series, we had no cases of heterotopic ossification, there were 3 cases of postraumatic arthritis (16.5 percent) and 5 cases of femoral head avascular necrosis (27.5 percent). Seven patients (37.5 percent) required total hip arthroplasty during their evolution. Patients Pipkin III and IV were those with the highest complication rates, requiring total hip arthroplasty in 66 percent of cases. Conclusion: The fractures of the femoral head are associated with high energy mechanisms, generally with hip dislocation and present complications with significant impact for the patient’ship, becoming a catastrophic injury when they correspond to Types III and IV of Pipkin Classification.

Objetivo: Describir los resultados clínicos y complicaciones en pacientes con fracturas de cabeza femoral utilizando la clasificación de Pipkin. Materiales y Métodos: Estudio retrospectivo y descriptivo. Se analizaron los casos de fracturas de cabeza femoral tratadas entre los años 1992 y 2008. Se registraron los antecedentes médicos del paciente y quirúrgicos de la cadera, lesiones asociadas, clasificación de Pipkin, tipo de tratamiento y la aparición de complicaciones. Resultados: Presentamos 18 casos de fracturas de cabeza femoral con un seguimiento clínico promedio de 10,3 años (rango de 2,3-18,7 años). Nuestra serie presentó 14 (78 por ciento) hombres, una edad promedio de 44,8 años, sin casos de patología previa de cadera. En 17 (95 por ciento) pacientes el mecanismo de lesión fue un accidente de tránsito. Se asociaron a luxación posterior en 17 (94 por ciento) y luxación anterior en 1 (6 por ciento) paciente. En 13 casos se realizó una reducción cerrada, en 4 reducción abierta y en 1 se realizó artroplastía total de cadera primaria por fractura cervical asociada. Se presentaron 5 (28 por ciento) fracturas Pipkin I, 4 (22 por ciento) Pipkin II, 1 (6 por ciento) Pipkin III y 8 (44 por ciento) Pipkin IV. Dentro de las complicaciones globales de nuestra serie, no hubo casos de calcificaciones heterotópicas, hubo 3 casos de artrosis postraumática (16,5 por ciento) y 5 casos de necrosis avascular de cabeza femoral (27,5 por ciento). Siete pacientes (37,5 por ciento) requirieron de artroplastía total de cadera durante su evolución. Los pacientes Pipkin tipo III y IV fueron los que presentaron las mayores tasas de complicación, requiriendo de artroplastía total de cadera en 66 por ciento de los casos. Conclusión: Las fracturas de cabeza femoral son lesiones provocadas por mecanismos de alta energía, asociadas a luxación de la cadera y provocan complicaciones con repercusión importante para la cadera del paciente, constituyendo una lesión catastrófica cuan...

Femoral Head Fractures / 대한정형외과학회잡지

9 Cases of femoral head fractures treated in Seoul National University Hospital were reviewed. They were classified according to Pipkin, and assessed according to Ebstein's criteria. The longest follow-up was 3 years and the shortest 6 months, the average being 1 year and 6 months. l. 8 cases were injured due to auto accident and there was no one who had worn seatbelt. 2. 1 case of intestine rupture and 2 cases of homothorax were accompanied. 3. There were 1 excellent, 1 good, and 1 poor results in 3 cases of Pipkin type 1, 1 fair result in 1 case of Pipkin type 2, 1 good and 1 fair results in 2 cases of Pipkin type 3, 1 good and 2 fair results in 3 cases of Pipkin type 4. 4. The following complications were encountered, 2 cases of sciatic nerve palsy, 1 case of avascular necrosis of femoral head, 1 case of traumatic arthritis.