Midterm results of trochanteric flip osteotomy technique for management of fractures around the hip

2017 ◽  
Vol 28 (2) ◽  
pp. 148-155 ◽  
Author(s):  
Vivek Trikha ◽  
Saubhik Das ◽  
Arkesh Madegowda ◽  
Prabhat Agrawal
Keyword(s):  
Femoral Head ◽  
Excellent Result ◽  
Hip Dislocation ◽  
Posterior Wall ◽  
Acetabular Fractures ◽  
Functional Evaluation ◽  
Midterm Results ◽  
Surgical Hip Dislocation ◽  
Surgical Dislocation ◽  
Trochanteric Flip Osteotomy

Introduction: In this study, we aimed to investigate safety and efficacy of the trochanteric flip osteotomy with surgical hip dislocation technique in selected displaced acetabular and femoral head fractures with clinico-radiological outcome and potential complications. Materials and methods: We retrospectively reviewed 32 patients from January 2009 to June 2014. Selected displaced acetabular fractures with comminution and/or cranial extension of posterior wall, marginal impaction, intraarticular fragment, femoral head fractures and hip fracture-dislocations were operated by this modified approach of trochanteric flip osteotomy and surgical hip dislocation. Patients were evaluated for fracture reduction, femoral head viability, trochanteric union, abduction power, and functional evaluation was done by Merle d’Aubigné-Postel scoring system. Minimum follow-up was 24 months. Results: Reduction was judged to be anatomical in 84.38% of cases, and within 1-3 millimetres in 9.38% of cases. All osteotomies healed in an anatomical position. Heterotopic ossification was found in 2 patients limited to Brooker class I. Osteonecrosis developed in 1 patient. 2 patients developed arthritis of the hip as sequelae of poor reduction. Abduction power was MRC 5/5 in all except in 1 patient (4/5). Mean Merle d’Aubigné-Postel score was 16.18; overall good to excellent result was achieved in 87.5% of cases. Conclusions: Trochanteric flip osteotomy with surgical dislocation allows better intraarticular assessment, control of intraarticular fragments, assists accurate reduction and the fixation of complex acetabular and femoral head fractures, without compromising femoral head vascularity and abductor strength. This technique has provided excellent midterm results in the management of complex injuries around the hip.

scholarly journals Avascular necrosis of the femoral head in the patients with posterior wall acetabular fractures associated with dislocations of the hip

2013 ◽  
Vol 60 (2) ◽  
pp. 65-69 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Jordan Saveski ◽  
Ivan Micic ◽  
Predrag Stojiljkovic ◽  
...  
Keyword(s):  
Femoral Head ◽  
Young Patients ◽  
Hip Dislocation ◽  
Posterior Wall ◽  
Acetabular Fractures ◽  
Type I ◽  
Severe Injuries ◽  
Stable Osteosynthesis ◽  
Posterior Hip Dislocation

Introduction: Acetabular fractures are severe injuries, mostly occured in young patients after traffic accident or fall from heights. Of the all acetabular fractures, posterior wall acetabular fractures are the most often observed. Regarding to mechanism of the injury, about 30% of these fractures are associated with posterior hip dislocation. Material and methods: The incidence of AVN in 18 patients with posterior wall acetabular fractures associated with dislocations of the hip is presented. Thompson-Epstein Scale (type I-V) was used as the classification of the injury. Kocher-Langenbeck surgical approach was achieved in all patients. Results: Average following time after surgery was 22,66 months (8-36 months). After that period the incidence of femoral head AVN was observed in 33,3%6. Femoral head AVN was observed in 5,55%1 of patient who was treated by the reduction of hip dislocation in first 24 hours after injury, while in patients with later reduction, femoral head AVN were observed in 27,77%5. Conclusion: Posterior wall acetabular fractures associated with hip dislocation are severe injuries. Urgent, closed reduction of the hip, early definitive stable osteosynthesis of acetabulum and the experience of surgical team are factors that greatly decrease the possibility for AVN occurrence. Later reduction, comminution of posterior wall of the acetabulum (Thompson-Epstein III et IV), impaction, chondral lesion of the femoral head and associated fractures of femoral head, increase the possibility for AVN occurrence.

scholarly journals Management of Pipkin Fractures Using a Safe Surgical Hip Dislocation

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Rita Henriques ◽  
Diogo Ramalho ◽  
Joaquim Soares do Brito ◽  
Pedro Rocha ◽  
André Spranger ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Surgical Approach ◽  
Trauma Surgery ◽  
Hip Dislocation ◽  
High Energy ◽  
Posttraumatic Arthritis ◽  
Surgical Hip Dislocation ◽  
Anatomical Reduction ◽  
Pipkin Fracture

Introduction. Pipkin fractures are rare events and usually occur as a consequence for high-energy trauma. Surgery to obtain anatomical reduction and fixation is the mainstay treatment for the majority of these injuries; nonetheless, controversy exists regarding the best surgical approach. Description of the Case. We present the case of a 41-year-old male, which sustained a type II Pipkin fracture following a motorcycle accident. In the emergency department, an emergent closed reduction was performed, followed by surgery five days later. Using a surgical hip dislocation, a successful anatomical reduction and fixation was performed. After three years of follow-up, the patient presented with a normal range of motion, absent signs for avascular necrosis or posttraumatic arthritis, but with a grade II heterotopic ossification. Discussion. Safe surgical hip dislocation allows full access to the femoral head and acetabulum, without increasing the risk for a femoral head avascular necrosis or posttraumatic arthritis. Simultaneously, this surgical approach gives the opportunity to repair associated acetabular or labral lesions, which explains the growing popularity with this technique. Conclusion. Although technically demanding, safe surgical hip dislocation represents an excellent option in the reduction and fixation for Pipkin fractures.

scholarly journals Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach

2020 ◽  
Vol 14 (3) ◽  
pp. 190-200 ◽  
Author(s):  
Mostafa M. Baraka ◽  
Hany M. Hefny ◽  
Mootaz F. Thakeb ◽  
Tamer A. Fayyad ◽  
Haytham Abdelazim ◽  
...  
Keyword(s):  
Slipped Capital Femoral Epiphysis ◽  
Alpha Angle ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Functional Score ◽  
Surgical Hip Dislocation ◽  
Level Of Evidence ◽  
Surgical Dislocation ◽  
Imhauser Osteotomy ◽  
The Mean

Purpose Treatment of moderate to severe stable slipped capital femoral epiphysis (SCFE) remains a challenging problem. Open reduction by modified Dunn procedure carries a considerable risk of osteonecrosis (ON). Imhauser osteotomy is capable of realigning the deformity without the risk of ON, but the remaining metaphyseal bump is implicated with significant chondro-labral lesions and accelerated osteoarthritis. We conducted this study to evaluate the efficacy and safety of Imhauser osteotomy combined with osteochondroplasty (OCP) through the surgical hip dislocation (SHD) approach. Methods A prospective series of 23 patients with moderate-severe stable SCFE underwent Imhauser osteotomy and OCP through SHD. The mean age was 14.4 years (13 to 20) and the mean follow-up period was 45 months (24 to 66). The outcome measures included clinical and radiological parameters and Harris hip score (HHS) was used as a functional score. Results The mean HHS improved significantly from 65.39 to 93.3. The limb length discrepancy improved by a mean of 1.72 cm. The mean flexion and abduction arcs showed a significant improvement (mean increase of 37.5° and 18.5°, respectively). The mean internal rotation demonstrated the most significant improvement (mean increase of 38.5°). All the radiographic parameters improved significantly; including anterior and lateral slip angles (mean improvement 37.52° and 44.37°, respectively). The mean alpha angle decreased by 39.19°. The articulo-trochanteric distance significantly increased to a mean of 23.26 mm. No cases of ON or chondrolysis were identified. Conclusion Combined Imhauser osteotomy and OCP through the surgical dislocation approach provide a comprehensive and safe management of moderate to severe stable SCFE. Level of evidence IV

scholarly journals Partial resection of the posterior wall for hip dislocation in severe acetabular protrusio

2020 ◽  
Vol 1 (7) ◽  
pp. 431-437
Author(s):  
Hugo A. Rodriguez ◽  
Felipe Viña ◽  
Meilyn A. Muskus
Keyword(s):  
Femoral Head ◽  
Surgical Technique ◽  
Hip Arthroplasty ◽  
Hip Dislocation ◽  
Posterior Wall ◽  
Partial Resection ◽  
Hip Arthroplasties ◽  
Acetabular Protrusio

Aims In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the posterior wall in severe protrusio. Methods This is a descriptive observational study, which describes the surgical technique of the partial resection of the posterior wall during hip arthroplasty in patients with severe acetabular protrusio operated on between January 2007 and February 2017. Results In all, 49 hip arthroplasties were performed. The average age of patients was 60 years, and idiopathic was the most frequent aetiology of protrusio. All patients were treated with femoral head autograft and no intra- or postoperative complications were reported. No patients required revision surgery. Conclusion Partial resection of the posterior wall demonstrated to be a safe surgical technique with 100% survival in a follow-up to ten years in total hip arthroplasty due to severe acetabular protrusio. Cite this article: Bone Joint Open 2020;1-7:431–437.

scholarly journals Can we predict femoral head vitality during surgical hip dislocation?

2014 ◽  
Vol 1 (2) ◽  
pp. 77-81 ◽  
Author(s):  
A. Aprato ◽  
A. Bonani ◽  
M. Giachino ◽  
M. Favuto ◽  
F. Atzori ◽  
...  
Keyword(s):  
Femoral Head ◽  
Hip Dislocation ◽  
Surgical Hip Dislocation
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