Published online Aug 18, 2021. doi: 10.5312/wjo.v12.i8.604
Peer-review started: April 26, 2021
First decision: June 16, 2021
Revised: June 20, 2021
Accepted: July 20, 2021
Article in press: July 20, 2021
Published online: August 18, 2021
Femoral head fractures (FHFs) are considered relatively uncommon injuries; however, open reduction and internal fixation is preferred for most displaced fractures. Several surgical approaches had been utilized with controversial results; surgical hip dislocation (SHD) is among these approaches, with the reputation of being demanding and leading to higher complication rates.
To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.
Major databases including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs. We extracted basic studies data, surgery-related data, functional outcomes, radiological outcomes, and postoperative complications. We calculated the mean differences for continuous data with 95% confidence intervals for each outcome and the odds ratio with 95% confidence intervals for binary outcomes. P < 0.05 was considered significant.
Our search retrieved nine studies meeting our inclusion criteria, with a total of 129 FHFs. The results of our analysis revealed that the average operation time was 123.74 min, while the average blood loss was 491.89 mL. After an average follow-up of 38.4 mo, a satisfactory clinical outcome was achieved in 85% of patients, with 74% obtained anatomical fracture reduction. Overall complication rate ranged from 30% to 86%, with avascular necrosis, heterotopic ossification, and osteoarthritis being the most common complications occurring at an incidence of 12%, 25%, and 16%, respectively. Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4% and 3.8%, respectively.
The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis, the formation of heterotopic ossification, and the development of posttraumatic osteoarthritis; however, it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.
Core Tip: In the past few years, surgical hip dislocation had been adopted by many trauma surgeons as an approach for femoral head fractures management. The current systematic review and metanalysis collected data from the most recent literature showed the efficacy of this approach in regards to obtaining acceptable functional and radiological outcomes as well as resulting in relatively low complication rates when compared with other approaches reported in the literature. However, it carries some unique complications such as trochanteric bursitis and trochanteric flip osteotomy nonunion.