Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

Purpose: Pipkin type IV femoral head (FH) fracture was thought as poor prognosis. There were several surgical approaches and treatments for this difficult fracture. However, there was no one treatment superior to another. We reviewed a serious of patients with Pipkin type IV FH fracture underwent surgery via a modified Gibson approach. Methods: We reviewed a consecutive series of nine patients with Pipkin type IV FH fracture under surgery via a modified Gibson approach between 2012 and 2013. The surgical procedure was completely described, and the radiological outcome and the functional outcome were also reviewed. Results: The mean follow-up duration was 17 (12–30) months. The mean Merle d’Aubigne score was 16 (8–19). Seven patients had anatomical reductions, and two had imperfect reductions by Matta’s grading. There was no early posttraumatic osteoarthritis during the follow-up period. One patient with early post-traumatic osteonecrosis 3 months after index surgery underwent total hip arthroplasty. Conclusions: Through this surgery approach to fix the FH and the acetabulum, the radiological and the functional results were satisfactory. We still need more patients with prospective study to find an optimal surgical approach for Pipkin type IV FH fracture.

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A case report of femoral head fracture with osteochondral lesion treated by osteosynthesis and biomimetic scaffold: 2-year clinical and radiological follow-up

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00362-x ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Alessandro Casiraghi ◽

Claudio Galante ◽

Marco Domenicucci ◽

Stefano Cattaneo ◽

Andrea Achille Spreafico ◽

...

Keyword(s):

Case Report ◽

Femoral Head ◽

Articular Surface ◽

Osteochondral Lesion ◽

Hip Dislocation ◽

Fracture Dislocation ◽

Osteochondral Lesions ◽

Femoral Head Fracture ◽

Osteochondral Scaffold

AbstractThe aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold.An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema.The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head.Study Design: Case report.

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3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1383-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Jinwu Wang ◽

Leyi Cai ◽

Linzhen Xie ◽

Hua Chen ◽

Xiaoshan Guo ◽

...

Keyword(s):

Femoral Head ◽

3D Printing ◽

Blood Loss ◽

Surgical Approach ◽

Type I ◽

Type Ii ◽

Femoral Head Fracture ◽

Hip Function ◽

The Mean

Abstract Background Femoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity. Patients and methods Between 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d’Aubigne scores. The reduction of the fracture was evaluated according to Matta’s criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented. Results Twelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25–48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d’ Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1). Conclusions The 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications. Trial registration We register our research at http://www.researchregistry.com. The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847.

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Posterior dislocation of left hip joint with closed fracture of left acetabulum Judet-Letournel type posterior wall, femoral head fracture, management and follow up: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2020.04.009 ◽

2020 ◽

Vol 71 ◽

pp. 85-90 ◽

Cited By ~ 1

Author(s):

Ismail Hadisoebroto Dilogo ◽

Uno Surgery Erwin ◽

Andra Hendriarto

Keyword(s):

Case Report ◽

Femoral Head ◽

Hip Joint ◽

Posterior Wall ◽

Posterior Dislocation ◽

Femoral Head Fracture ◽

Closed Fracture ◽

Fracture Management

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First-Person Long-term Follow-up Using Autologous Mosaicplasty for Osteochondral Lesion Accompanying Femoral Head Fracture

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000000439 ◽

2016 ◽

Vol 30 (2) ◽

pp. e70-e74 ◽

Cited By ~ 5

Author(s):

Jonathan A. Zelken

Keyword(s):

Femoral Head ◽

Osteochondral Lesion ◽

First Person ◽

Femoral Head Fracture ◽

Long Term Follow Up

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Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04800-w ◽

2021 ◽

Vol 22 (S2) ◽

Author(s):

Domenico De Mauro ◽

Giuseppe Rovere ◽

Amarildo Smakaj ◽

Silvia Marino ◽

Gianluca Ciolli ◽

...

Keyword(s):

Femoral Head ◽

Internal Fixation ◽

Open Reduction ◽

Case Series ◽

Hip Dislocation ◽

Harris Hip Score ◽

Femoral Head Fracture ◽

Surgical Hip Dislocation ◽

Modified Harris Hip Score

Abstract Background The purpose of the study is to evaluate clinical and radiological outcomes in those patients with femoral head fracture, treated with open reduction and internal fixation through Gibson approach and Ganz flip trochanter osteotomy. The treatment of Pipkin fractures is very challenging, especially for small trauma centers, because of the unusual fracture patterns and high-level surgical skills required. Case presentation Between 2017 and 2020, nine cases of Pipkin fractures came to the Emergency Department at the Trauma Center of our Hospital in Rome. Inclusion criteria were the diagnosis of femoral head fracture, the open reduction and internal fixation as surgical choice and at least 24 months follow-up. Patients older than 65 years and those treated through total hip replacement or combined hip procedure (CHP) were excluded. Thus, five patients were included in our case series. The clinical outcome was evaluated according to Western Ontario and McMaster Universities Arthritis Index, Vail Hip score, modified Harris Hip score and Merle D’Aubignè Postel score. Radiographic assessment was scored according to Epstein-Thompson classification and heterotopic ossification was assessed through Brooker classification. The mean follow-up was 24 months (range 12-24). Average modified Harris Hip score was 92.1 points (range 75.9–100), and the average Vail score was 81.8 (range 55-95). WOMAC score was assessed in three different subscales, pain (A), stiffness (B) and physical condition (C), with the following results: 1.4 A (range 0-7), 1.2 B (range 0-6) and 6.4 C (range 0-22). Merle d’Aubignè Postel score resulted excellent for four patients and good for one patient. According to Epstein-Thompson score of the radiological outcome, four patients showed a good result and one a fair result. No mechanical or infective complications occurred in the five patients. Conclusions Gibson’s approach and surgical hip dislocation through Ganz trochanteric flip osteotomy allow a good exposure of the femoral head and acetabulum, giving us the possibility to perform an anatomical reduction of the fracture. In our case series, satisfactory clinical and radiological short-term results were obtained without significant complications.

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Shelf Acetabuloplasty in the Treatment of Severe Legg-Calvé-Perthes Disease: Good Outcomes at Midterm Follow-Up

BioMed Research International ◽

10.1155/2013/859483 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Andrzej Grzegorzewski ◽

Marek Synder ◽

Krysztof Kmieć ◽

Karol Krajewski ◽

Michał Polguj ◽

...

Keyword(s):

Femoral Head ◽

Type I ◽

Leg Length ◽

Midterm Results ◽

Type Iv ◽

Center Edge ◽

The Mean ◽

Shelf Acetabuloplasty ◽

Center Edge Angle

The aim of the study was to retrospectively review results of operative treatment for coverage deficit of femoral head in children with severe epiphysis displacement in Legg-Calvé-Perthes (LCP) disease. The material included 23 shelf acetabuloplasty procedures for LCP disease. The average age at diagnosis was 8.1 years (range 4–12). Mean follow-up was 5.8 years (range from 2.2 to 11.2 years). Mean Reimer's index decreased statistically significantly from a mean of 32% before surgery to 10.0% at the last follow-up (P<0.00001). The mean Wiberg center-edge angle increased also statistically significantly from a mean of 17.3° before procedure to 32.3° at the last follow-up (P<0.00001). According to the Stulberg classification, type I was observed in 2, type II in 13, type III in 6, and type IV in 2 hips. There were no differences in the range of motion or leg length discrepancy in preoperative and postoperative standing. Partial, not significant, bone graft resorption was noted in 6 cases in the first 6–9 months after surgery. To conclude, shelf acetabuloplasty allows achieving good midterm results in the treatment of severe stages of LCP disease. The procedure improves coverage of femoral head and allows its remodelling.

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Hip arthroscopy-assisted reduction and fixation for femoral head fracture dislocations: Clinical and radiographic short-term results of seven cases

Journal of Orthopaedic Surgery ◽

10.1177/2309499019881865 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901988186 ◽

Cited By ~ 2

Author(s):

Shan-Ling Hsu ◽

Chung-Yang Chen ◽

Jih-Yang Ko ◽

Chi-Hsiang Hsu ◽

Hao-Chen Liu ◽

...

Keyword(s):

Femoral Head ◽

Arthroscopic Surgery ◽

Fracture Dislocation ◽

Harris Hip Score ◽

Consecutive Series ◽

Femoral Head Fracture ◽

Articular Fractures ◽

Fracture Dislocations ◽

The Mean

Purpose: Femoral head fracture dislocations are serious articular fractures that are associated with soft tissue injuries and are challenging to treat. Arthroscopic surgery may be a way to treat fracture reduction and fixation, thereby avoiding the need for extensive arthrotomy. Methods: We followed up a consecutive series of seven patients with femoral head fracture dislocation via a scope-assisted percutaneous headless screw fixation between 2016 and 2017. The clinical and radiological results were assessed. Results: The locations of the fracture were all involving infra-foveal area. The mean follow-up duration was 18 (range 12–24) months. The mean Harris hip score was 90.8 (range 88–93) at the latest follow-up. None of the patients showed early osteoarthritis, heterotopic ossification, or avascular necrosis. The average maximal displacement of the fracture site was improved from preoperative 6.79 mm (range 4.21–12.32) to postoperative 2.76 mm (range 0.97–3.97). Concomitant intra-articular hip lesions secondary to traumatic hip dislocation can also be treated. Conclusion: Managing the infra-foveal fracture of the femoral head using arthroscopic reduction and fixation with headless screws can be a safe and minimally invasive option. More patients and longer follow-up are needed for a definite conclusion.

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Management of a Pipkin Type III Femoral Head Fracture Via Ganz Approach with a Cannulated Lag Screw & Herbert Screw

10.21203/rs.3.rs-588260/v1 ◽

2021 ◽

Author(s):

Liangcong Hu ◽

Xudong Xie ◽

Bobin Mi ◽

Le Grange Jehane Michael. ◽

Tiantian Wang ◽

...

Keyword(s):

Femoral Head ◽

Complication Rate ◽

Femoral Head Fracture ◽

Postoperative Function ◽

Herbert Screw ◽

Type Iii ◽

Lag Screw ◽

Harris Score ◽

Post Traumatic

Abstract Objective: To evaluate the medium - to long-term efficacy of a Ganz approach and cannulated lag screw combined with Herbert screw, in the management of a Pipkin type III femoral head fracture.Methods:Retrospective analysis was performed on 11 patients (6 males, 5 females) who sustained Pipkin type III femoral head fractures and were managed with a cannulated lag screw, combined with Herbert screw, inserted using the Ganz approach and who were admitted to our department between June 2018 to June 2020. Perioperative indicators, postoperative function and follow-up complications at 9 months after surgery, Harris score at 6 and 9 months after surgery, Thompson-Epstein score, hip femoral head necrosis and incidence of post traumatic hip arthritis were analysis.Results:10 patients completed follow-up, with an average follow-up time of (13.7 ± 2.1) months. The mean operative time was (100.3 ± 23.67) minutes, intraoperative blood loss was (138.6 ± 50.18) ml, peripheral blood hemoglobin (Hb) was (105.6 ± 18.94) g/L 24 hours after surgery, and the complication rate was 1/10 2 weeks after surgery. The Harris Hip Scores for joint function at 6 and 9 months after the operation were (68.6 ± 5.49) points and (88.8 ± 5.77) points respectively. The excellent and good rate in the last follow-up was 80% (Thompson-Epstein score). The complication rate was 10%.Conclusion:A cannulated lag screw combined with a Herbert screw and inserted via the Ganz approach, is an effective method for the treatment of Pipkin type III fractures.

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Traumatic Hip Dislocation with Associated Femoral Head Fracture

Case Reports in Orthopedics ◽

10.1155/2015/865786 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

H. Dortaj ◽

A. Emamifar

Keyword(s):

Femoral Head ◽

Full Range ◽

Hip Dislocation ◽

High Energy ◽

Femoral Head Fracture ◽

Hip Instability ◽

The Right ◽

Dislocation Of The Hip ◽

Critical Injury

Dislocation of the hip is a critical injury that results from high-energy trauma. This paper describes a case of posterior dislocation of the right hip in a 35-year-old woman with associated ipsilateral femoral head fracture. Initial treatment included reduction of the right hip through posterior approach and fixation of the femoral head fracture with three absorbable screws. After 15-month follow-up, a full range of motion has been achieved and there are no signs of avascular necrosis, hip instability, or limping. The authors describe their method of surgery.

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