Analysis of effectiveness of greater trochanteric osteotomy approach and K-L posterior approach in patients with type Ⅳ Pipkin fracture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of two surgical approaches in the treatment of type Ⅳ Pipkin fracture. Methods: The clinical data of 15 patients with type Ⅳ Pipkin fracture treated surgically between July 2013 and June 2018 were retrospectively analyzed. According to different surgical approaches, they were divided into group A (8 cases, using K-L posterior approach) and group B (7 cases, using greater trochanter osteotomy approach). There was no significant difference in gender, age, cause of injury, and interval from injury to operation between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, fracture healing time, and complications of the two groups were recorded. Hip joint function recovery was evaluated according to Thompson-Epstein functional evaluation system. Results: All the 15 patients were followed up 1-5 years, with an average of 2.5 years. There was no significant difference in operation time between the two groups ( t=14.681, P=0.100); the incision length, intraoperative blood loss, and fracture healing time in group A were all greater than those in group B, and the hospital stay was shorter than that in group B, showing significant differences ( P<0.05). In group A, 1 patient presented hip pain, clasthenia, and limited mobility after operation, 1 patient presented ossifying myositis, 1 patient presented osteonecrosis of the femoral head, 1 patient presented fat liquefaction of incision, and 1 patient presented sciatica, with a complication incidence of 62.5%. Postoperative hip pain occurred in 1 patient and ossifying myositis in 2 patients in group B, with a complication incidence of 42.9%. There was no significant difference in the incidence of complications between the two groups ( χ2=-0.735, P=0.462). At last follow-up, according to Thompson-Epstein functional evaluation system, the results in group A were excellent in 3 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 62.5%; in group B, the results were excellent in 4 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 85.7%. There was no significant difference in good and fair rate between the two groups ( χ2=-0.990, P=0.322). Conclusion: K-L posterior approach is more convenient in the fracture treatment during operation, but it has greater trauma, greater vascular damage, and more blood loss. The greater trochanter osteotomy approach can better protect the blood supply of femoral head, shorten the operation time, reduce intraoperative blood loss, and reduce postoperative complications. It is an ideal way in the surgical treatment of type Ⅳ Pipkin fracture.

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>

Arthroscopic Fragment Excision of Pipkin Type I Displaced Femoral Head Fracture: A Case Report / 대한고관절학회지

There has been a variety of options for treatment of femoral head fracture with hip dislocation according to the Pipkin classification. Pipkin type I fractures with minimal displacement have been treated conservatively. However, in cases where the fracture was displaced or reduced incongruently, it has been treated by open fragment excision or fixation after reduction. In our case, the patient was a 62-year-old man who sustained a displaced fracture of Pipkin type I. We achieved a satisfactory outcome by arthroscopic excision of a displaced bony fragment and small bony fragments that could not be confirmed by pre-operative imaging study. Therefore, we report on the case with a review of the literature.

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...

Tratamiento quirúrgico de fractura de cabeza femoral mediante luxación controlada de cadera: resultados a mediano plazo / Surgical treatment through controlled hip dislocation for femoral head fractures: mid term results

Femoral head fractures associated to hip dislocations are uncommon lesions. Most reports present only short-term results. Objectives: To show functional outcome after a mid term follow up of patients with Pipkin II femoral head fractures treated operatively. Materials and Methods: A retrospective and descriptive evaluation of a 4 consecutive case series (four men, mean age of 36.5 years) treated operatively with an 89-month average follow up (range form 72-108 month). Controlled femoral head dislocation was performed in all patients and two 2.4 mm screws were used for fixation. At final follow up, the Harris Hip Score (HHS) and complications were assessed. Results: No immediate or late complications were reported. The mean HHS was of 95 points (range from 89 to 100 points).No signs of postraumatic arthritis or femoral head osteonecrosis were seen at the last radiographic assessment. Conclusion: in this series of patients with Pipkin II femoral head fractures mid-term functional results are good and no postraumatic arthritis or femoral head osteonecrosis were observed at final follow-up.

Las fracturas de cabeza femoral, asociada a luxación de cadera, corresponden a lesiones infrecuentes. La mayoría de los estudios reportan resultados a corto plazo. Objetivo: Describir el resultado funcional de pacientes con fractura Pipkin II operados con seguimiento a mediano plazo. Material y Métodos: Evaluación retrospectiva y descriptiva de una serie consecutiva de 4 pacientes (cuatro hombres, mediana de edad 36,5 años) operados con un seguimiento de mediana de 89 meses (72-108 meses). En todos los casos se realizó luxación controlada de la cabeza femoral y se utilizaron 2 tornillos de 2,4 mm. Se evaluaron complicaciones y Harris Hip Score (HHS) al último control clínico. Resultados: No se presentaron complicaciones tempranas ni tardías. El HHS promedio fue de 95 puntos (89-100 puntos). La última evaluación radiográfica no demostró signos de artrosis postraumática ni signos de necrosis avascular de cabeza femoral. Conclusión: En este grupo de pacientes con fractura de Pipkin tipo II los resultados funcionales a mediano plazo son buenos, no registrándose en el seguimiento artrosis de cadera postraumática ni necrosis avascular de la cabeza femoral.

Treatment of Traumatic Posterior Dislocation of the Hip Joint Associated with Femoral Head Fracture

PURPOSE: This study examined the treatment of patients with posterior hip dislocation and femoral head fracture, according to the Pipkin classification, and we analyzed their clinical and radiological results. MATERIALS AND METHODS: The subjects consisted of 45 patients who were treated for posterior hip dislocation and femoral head fracture. The subjects had an average age of 39, and 38 were men and 7 were women. The average follow-up period was 33 months. The cause of injury was traffic accident in 41 cases and falling for the other four cases. According to the classification, there were 26 Type I cases, 5 Type II cases, 1 Type III case and 13 Type IV cases. The treatment methods were selected according to the patients' condition and the form of fracture. The Ebstein criteria and the Merle d'Aubigne and Postel score were used to determine whether there was a combined injury and to examine the clinical and radiological results. RESULTS: All the cases classified as Type I, II and III showed good or excellent clinical results. A primary osteosynthesis was performed on the Type III cases according to the patient's age and condition, with particularly good results. An anatomical reduction in the early stages affected the clinical results of the Type IV cases. The observed complications were posttraumatic osteoarthritis (38.4%) and avascular necrosis (15.3%). CONCLUSION: The prognosis was determined by the injury's initial severity, the time for reduction and the anatomical reduction and firm fixation of the femur and the fracture fragment of the acetabulum.

Fixation of Pipkin Fractures with Acutrak Screws: A Report of Three Cases

Femoral head fracture with posterior dislocation of the hip occurs relatively infrequently. Many treatment options exist for this condition. The fracture fragments of the femoral head can be internally fixed or removed depending on the severity of fracture comminution, fragment size, and location on the weight-bearing surface of the femoral head. In Pipkin type I and II fractures, the fragments are typically located anteriorly. Hence, it is important to strongly fix the fracture fragments to the femoral head rather than to excise them, in the interest of securing a better outcome. Even if the fragments are caudal to the fovea centralis, the discarding of large portions of the femoral head that are amenable to rigid fixation is not preferred. Three femoral head fractures were treated using Acutrak screws incorporated with a self-compression mechanism. We report the results and consider ways to use Acutrak screws.

Operative treatment of Pipkin fracture / 重庆医科大学学报

Objective: To evaluate the result of operative treatment of hip dislocation combined with fractures of the femoral head. (Pipkin fracture). Methods: 32 cases were classified according to Pipkin classification,including 8 cases of type Ⅰ,15 cases of type Ⅱ,3 cases of type Ⅲ and 6 cases of type Ⅳ. Various surgical procedures were taken according to the classifications,ages,preoperative images and intraoperative check of the patients. Open reduction and fixation were taken in 30 patients and total hip replacement were performed in 2 patients. Results: Follow-up averaged 28 months,the post-operative function in 27 cases of internal fixation were: excellent in 11 cases (40.7%),good in 11 cases(40.7%), fair in 3 cases(11.1%),poor in 2 case (7.5%). The excellent rate was 81.4%. Conclusion: The key to good result for treating Pipkin fracture is early diagnosis and early operation. Operative approach should be chosen with various situations. Internal fixation with absorbable screw is an ideal method.

Treatment of Femoral Head Fracture with Traumatic Posterior Dislocation of the Hip

PUEPOSE: To evaluate the treatment results and complication of a femoral head fracture with posterior dislocation of the hip according to the Pipkin classification. MATERIALS AND METHODS: Ten cases of Thompson-Epstein type V femoral head fracture with a posterior dislocation of the hip were evaluated. According to the Pipkin classification, 5 cases were type I, 1 case was type III, and 4 cases were type IV. The average age at time of trauma was 38 (19~72) years, and the causes were traffic accidents in 9 cases and falls in 1 case. The average follow-up period was 33 (13~79) months. A reduction of the fracture was performed within 6 hours in 9 cases and 12 hours in 1 case. When the stability was achieved after the reduction, the choice of further treatment was made from either conservative treatment while maintaining skeletal traction, or surgical treatment according to the fracture type and instability. The complications were evaluated by a physical examination, simple radiography, computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: In Pipkin type I fractures, 4 cases were treated with conservative treatment and 1 case was treated with surgical treatment. One case of Pipkin type III fracture was treated with primary total hip arthroplasty. In Pipkin type IV fractures, 2 cases were treated surgically using a plate and 2 cases were treated with conservative treatment with skeletal traction. Bone union was achieved in all cases. One case of mild posttraumatic arthritis and 1 case of avascular necrosis was found, respectively in Pipkin type IV. CONCLUSION: The extent of the initial injury has an effect on the prognosis of a hip fracture and dislocation.