Great trochanteric digastric osteotomy and surgical dislocation for treatment of Pipkin Ⅳ fractures / 中华创伤骨科杂志

ABSTRACT

Objective To discuss the clinical outcomes of trochanteric digastric osteotomy and surgical hip dislocation for treatment of Pipkin Ⅳ fractures. Methods We retrospectively reviewed the 12 patients with Pipkin Ⅳ fracture who had been treated by trochanteric digastric osteotomy and surgical hip dislocation from February 2012 to June 2016. They were 10 males and 2 females, with an average age of 44. 1 years ( from 24 to 63 years ) . According to the Pipkin classification for femoral head fractures, 9 fractures were type Ⅰand 3 type Ⅱ; according to Letournel-Judet classification for acetabular fractures, 10 were posterior wall fractures ( 9 belonging to the posterior superior subgroup ) and 2 transverse plus posterior wall fractures ( one involving the posterior wall belonging to the posterior superior subgroup ) . The operation time, blood loss, complications and functional results were recorded. Results The operation time averaged 165 min ( from 150 to 195 min ); the blood loss averaged 850 mL ( from 500 to 1, 200 mL ) . A spring plate was used additionally for posterior wall fracture in 7 cases. All the 12 cases obtained an average follow-up of 19 months ( from 6 to 52 months ) . Motion function was fully recovered from 6 weeks to 4 months after operation in 2 cases of preoperative incomplete sciatic nerve injury and in one case of iatrogenic incomplete sciatic nerve injury. Anatomical reduction was achieved in all femoral head fractures. According to the Matta criteria for acetabular fractures, anatomical reduction was achieved in 9 cases, good reduction in 2 and poor reduction in one. Heterotopic ossification occurred in 4 cases ( gradeⅠin one, gradeⅡin 2 and gradeⅢin one by the Brooker grading system ) . The trochanteric osteotomy was repeated in one case. No femoral head avascular necrosis was found. According to the modified Merle d'Aubigné and Postel scoring at the final follow-ups, the functional results of the affected hip were excellent in 4 cases, good in 7 and poor in one. Conclusion Trochanteric digastric osteotomy and surgical hip dislocation is a safe and effective treatment for Pipkin Ⅳ fractures.