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Schaffer NE, Luther L, Tatman LM, Mitchell PM. Femoral Head Fractures: Evaluation, Management, and Outcomes. J Am Acad Orthop Surg 2024; 32:929-937. [PMID: 38968607 DOI: 10.5435/jaaos-d-23-01121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/18/2024] [Indexed: 07/07/2024] Open
Abstract
Fractures of the femoral head typically occur after high-energy trauma. Radiographs and cross-sectional imaging are used to appropriately classify and identify associated injuries or morphologic characteristics that may influence management. Identification of the radiographic and clinical hallmarks of an irreducible variant is critical to optimizing the patient's outcome. Nonsurgical treatment can be used in the setting of small, infrafoveal femoral head fractures without hip instability. When surgical treatment is indicated, an anterior (Smith-Petersen), posterior (Kocher-Langenbeck), or surgical hip dislocation approach may be used depending on injury details and surgeon preference. The purpose of this review was to summarize current evidence on femoral head fractures regarding indications, variant patterns, surgical approaches, and outcomes.
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Affiliation(s)
- Nathaniel E Schaffer
- From the Western Washington Medical Group, Everett, WA (Schaffer), and the Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Luther, Tatman, and Mitchell)
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2
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Gänsslen A, Lindtner RA, Krappinger D, Franke J. Pipkin fractures: fracture type-specific management. Arch Orthop Trauma Surg 2024; 144:4601-4614. [PMID: 39349876 DOI: 10.1007/s00402-024-05576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 09/10/2024] [Indexed: 11/20/2024]
Abstract
Femoral head fractures are rare, which limits the experience of individual surgeons with these injuries. This overview examines historical data, injury mechanisms, and classification systems, as well as epidemiological data from larger patient cohorts. Significant controversies persist regarding the optimal surgical approach and fracture-type-specific treatment for Pipkin fractures. The literature is often inconsistent, as many studies fail to differentiate between specific fracture types and instead report aggregated results, leading to ambiguous conclusions about the most effective treatment strategies. Thus, this article reviews fracture-type-specific outcomes of both non-operative and operative treatments over the past 25 years and summarizes their clinical implications, with the aim of assisting surgeons in their decision-making processes.
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Affiliation(s)
- Axel Gänsslen
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- University Hospital, Johannes Wesling Hospital, Hans-Nolte-Straße 1, 32429, Minden, Germany.
| | - Richard A Lindtner
- Department of Orthopaedic and Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Orthopaedic and Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Jochen Franke
- Trauma Department, Tauernkliniken, Paracelsusstraße 8, 5700, Zell, Austria
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3
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Kloub M, Holub K, Peml M, Urban J, Látal P. Closed reduction and minimally invasive screw osteosynthesis of Pipkin femoral head fractures. J Appl Biomed 2023; 21:1-6. [PMID: 37016774 DOI: 10.32725/jab.2023.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Femoral posterior hip dislocation with associated femoral head fractures (Pipkin fractures) are rare high-energy injuries. Published treatment modalities involve conservative treatment, head fragment resection, open reduction and internal fixation, and total hip replacement. The experience with mini-invasive screw osteosynthesis of these fractures is the main focus of our study. METHODS Seven Pipkin fractures (five Pipkin II and two Pipkin I) in six patients were treated by closed reduction of hip dislocation, followed by minimal invasive lag screw osteosynthesis. Cancellous screw(s) were inserted from the incision on the lateral hip through the femoral neck to the reduced fracture fragment. In all patients, postoperative CT was performed to check the quality of surgery. Active physiotherapy with immediate toe-touch weight bearing was the routine postoperative protocol. In all patients, radiological and clinical results were evaluated with the Thompson Epstein, Merle d'Aubigne and Postel score, and Harris hip score. RESULTS All fractures united, and all femoral heads survived. Infectious complications were not observed, and no secondary surgery was needed. After an average follow-up of 18.4 months, the average Merle d'Aubigne and Postel score was 17.7 points, while the mean Harris hip score reached 98.1 points. The majority of patients achieved an excellent Thompson-Epstein clinical and radiological outcome. All patients returned to their original occupation. CONCLUSIONS Mini-invasive screw osteosynthesis can be used for the treatment of Pipkin type I-II femoral head fractures. Successful reduction of hip dislocation and head fracture is necessary for using this technique. Long-term follow-up is necessary to confirm this technique.
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Rojas-Sayol R, De Caso J, Valera M. Arthroscopic-Assisted Percutaneous Fixation of a Femoral Head Fracture (Pipkin II): A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00027. [PMID: 36040067 DOI: 10.2106/jbjs.cc.22.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE Fractures of the femoral head are infrequent injuries with potentially devastating complications. Pipkin type II fractures often require surgical fixation. It involves intraarticular approaches that may increase the inherent morbidity of these fractures. Hip arthroscopy minimizes surgical aggression and allows for direct control of fracture reduction. We present a case report of an arthroscopic-assisted percutaneous fixation of a Pipkin-II femoral head fracture. A hip arthroscopy without traction and percutaneous screw fixation was conducted under arthroscopic and fluoroscopic guidance. CONCLUSION Arthroscopic-assisted percutaneous fixation is a useful technique for optimal femoral head fracture treatment and may also minimize surgical morbidity and optimize early recovery.
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Affiliation(s)
- Roger Rojas-Sayol
- Orthopedic Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - J De Caso
- Trauma Orthopaedic Surgery Unit, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Valera
- Hip Orthopaedic Surgery Unit, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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5
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Chiron P, Reina N. Dislocation fracture of the femoral head in adult. EFORT Open Rev 2022; 7:375-383. [PMID: 35638606 PMCID: PMC9257734 DOI: 10.1530/eor-22-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The smaller the head fragment, the more likely it is located at the bottom and in front of the femoral head, which then determines the most suitable approach. A CT scan is essential after reduction and before resumption of weight-bearing to verify the size and congruence of the fragments and whether there are foreign bodies and/or a fracture of the posterior wall. Classifications should include the size of the fragment and whether or not there is an associated fracture of the acetabulum or femoral neck (historical ‘Pipkin’, modernised ‘Chiron’). In an emergency, the dislocation should be rectified, without completing the fracture (sciatic nerve palsy should be diagnosed before reduction). A hip prosthesis may be indicated (age or associated cervical fracture). Delayed orthopaedic treatment is sufficient if congruence is good. A displaced fragment can be resected (foreign bodies and ¼ head), reduced and osteosynthesised (⅓ and ½ head), and a posterior wall fracture reduced and osteosynthesised. Small fragments can be resected under arthroscopy. The approach is medial (Luddloff, Ferguson, Chiron) to remove or osteosynthesise ⅓ or ¼ fragments; posterior for ½ head or a fractured posterior wall. The results remain quite good in case of resection or an adequately reduced fragment. Long-term osteoarthritis is common (32%) but well tolerated with a low rate of prosthetisation. Avascular necrosis remains a possible complication (8.2%). Sciatic nerve palsy (4% of fracture dislocations) is more common for dislocations associated with posterior wall fractures.
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Affiliation(s)
- Philippe Chiron
- Orthopédie Traumatologie, Secteur A, Batiment riquet, étage 5, CHU Toulouse, Toulouse Cedex 9, France
| | - Nicolas Reina
- Orthopédie Traumatologie, Secteur A, Batiment riquet, étage 5, CHU Toulouse, Toulouse Cedex 9, France
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6
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Lehmann W, Spering C. Pipkin-Frakturen. Unfallchirurg 2022; 125:313-322. [DOI: 10.1007/s00113-022-01153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/24/2022]
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7
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Menger MM, Braun BJ, Herath SC, Küper MA, Rollmann MF, Histing T. Fractures of the femoral head: a narrative review. EFORT Open Rev 2021; 6:1122-1131. [PMID: 34909230 PMCID: PMC8631236 DOI: 10.1302/2058-5241.6.210034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fractures of the femoral head are rare injuries, which typically occur after posterior hip dislocation. The Pipkin classification, developed in 1957, is the most commonly used classification scheme to date. The injury is mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a significant height. Emergency treatment consists of urgent closed reduction of the hip joint, followed by non-operative or operative treatment of the femoral head fracture and any associated injuries. There is an ongoing controversy about the suitable surgical approach (anterior vs. posterior) for addressing fractures of the femoral head. Fracture location, degree of displacement, joint congruity and the presence of loose fragments, as well as concomitant injuries are crucial factors in choosing the adequate surgical approach. Long-term complications such as osteonecrosis of the femoral head, posttraumatic osteoarthritis and heterotopic ossification can lead to a relatively poor functional outcome. Cite this article: EFORT Open Rev 2021;6:1122-1131. DOI: 10.1302/2058-5241.6.210034
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Affiliation(s)
- Maximilian M Menger
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Benedikt J Braun
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Steven C Herath
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Markus A Küper
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Mika F Rollmann
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
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8
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Articular Femoral Head Fracture Management: A Meta-analysis of Literature. Indian J Orthop 2021; 55:304-313. [PMID: 34306543 PMCID: PMC8275725 DOI: 10.1007/s43465-021-00431-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/20/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Articular fractures of the proximal femur are seldom encountered and there are few studies in literature regarding this topic. To date, only a few large series have adequate follow-up and exhaustive description of treatment and outcome, which, however, often result incomplete and do not allow a comparison. Since there are still uncertainties and debates on which the treatment gold standard should be, the goal of the present study is to carry out a meta-analysis on type I and II Pipkin fracture management to establish the best treatment according to EBM. METHODS Studies regarding acetabular fractures of the femur head were identified from Google Scholar, Cochrane Library, Medline, ScienceDirect and PubMed; gray studies were searched from the included references' literature, and using general search engines and Social media; the query to be temporally extended from 1996 to 2020. Only comparative studies were included; we ruled out case-reports, case series, author's opinion, register databases. RESULTS Comparing conservative and surgical treatment, we found evidence of a better outcome choosing surgical treatment. We found a significant better outcome with open reduction internal fixation, instead of fragment excision. Comparing failure rate of surgical approaches, we found no statistically significant difference. CONCLUSION Our study proves that there is evidence in favor of operative treatment rather than conservative in complete or displaced Pipkin fracture Type I + II; open reduction internal fixation should be preferred rather than fragment excision, whenever possible. LEVEL OF EVIDENCE III. Therapeutic.
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9
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Liu Y, Dai J, Wang XD, Guo ZX, Zhu LQ, Zhen YF. Open reduction and Herbert screw fixation of Pipkin type IV femoral head fracture in an adolescent: A case report. World J Clin Cases 2021; 9:898-903. [PMID: 33585637 PMCID: PMC7852633 DOI: 10.12998/wjcc.v9.i4.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Femoral head fracture is extremely rare in children. This may be the youngest patient with femoral head fracture ever reported in the literature. There are few pediatric studies that focus on cases treated with open reduction via the modified Hardinge approach.
CASE SUMMARY A 14-year-old female adolescent suffered a serious traffic accident when she was sitting on the back seat of a motorcycle. A pelvic radiograph and computed tomography revealed a proximal femoral fracture and slight acetabular rim fracture. This was diagnosed as a Pipkin type IV femoral head fracture. An open reduction and Herbert screw fixation was performed via a modified Hardinge approach. After 1-year follow-up, the patient could walk without aid and participate in physical activities. The X-ray results showed that the fractures healed well with no evidence of complications.
CONCLUSION Open reduction and Herbert screw fixation is an available therapy to treat Pipkin type IV femoral head fractures in children.
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Affiliation(s)
- Yao Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Jin Dai
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Xiao-Dong Wang
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Zhi-Xiong Guo
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Lun-Qing Zhu
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Yun-Fang Zhen
- Department of Orthopaedics, Children’s Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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10
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Hsu SL, Chen CY, Ko JY, Hsu CH, Liu HC, Lu YD. Hip arthroscopy-assisted reduction and fixation for femoral head fracture dislocations: Clinical and radiographic short-term results of seven cases. J Orthop Surg (Hong Kong) 2020; 27:2309499019881865. [PMID: 31640467 DOI: 10.1177/2309499019881865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
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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Affiliation(s)
- Shan-Ling Hsu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
- Department of Nursing, Fooyin University, Kaohsiung
| | - Chung-Yang Chen
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Jih-Yang Ko
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chi-Hsiang Hsu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Hao-Chen Liu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Yu-Der Lu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
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Alfikey A, El-Bakoury A, Karim MA, Farouk H, Kaddah MA, Abdelazeem AH. Role of arthroscopy for the diagnosis and management of post-traumatic hip pain: a prospective study. J Hip Preserv Surg 2019; 6:377-384. [PMID: 32015890 PMCID: PMC6990388 DOI: 10.1093/jhps/hnz052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 11/29/2022] Open
Abstract
The current published literature regarding the role of hip arthroscopy in the diagnosis and management of post-traumatic hip pain is still limited. Therefore, we conducted the present prospective study to determine the value of hip arthroscopy in the diagnosis and management of various causes of hip pain after traumatic conditions. The present study included a prospective cohort of 17 patients with symptomatic post-traumatic hip pain. It was conducted between July 2013 and May 2018. The mean age was 22 (19-29) years and the mean follow-up was 24 (r: 7-36) months. Prior to surgery, every eligible patient underwent assessment of functional status using the Modified Harris Hip Score, Oxford hip score (OHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. All patients underwent arthroscopic management for their diagnosed pathologies. The most commonly encountered diagnosis was labral tear (58.8%), followed by ligamentum teres tear (35.3%) and loose intra-articular fragments (29.4%). In addition, 52.9% of the patients had associated CAM lesion and 11.8% had associated Pincer lesion. The mHSS, OHS and WOMAC score showed significant improvement in the post-operative period (P < 0.001), all the 17 patients had 100% Patient Acceptable Symptomatic State; only one patient did not achieve minimal clinical importance difference. One case underwent labral debridement for failed labral repair (5.8%), another patient developed maralgia paraesthetica (5.8%). In conclusion, hip arthroscopy is a useful and effective minimally invasive procedure for the diagnosis and management of selected patients with post-traumatic hip pain. Moreover, hip arthroscopy was safe technique with no reported serious adverse events.
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Affiliation(s)
- Arafat Alfikey
- Orthopaedic Department, Khoula Hospital, Mina alfahl, P.O. Box: 90, P.C: 116, Muscat, Oman
| | - Ahmed El-Bakoury
- Orthopaedic Department, University of Calgary, Calgary, Canada
- Orthopaedic Department, Plymouth University Hospitals NHS Trust, Plymouth, UK
- Orthopaedic Department, University of Alexandria, Alexandria, Egypt
| | - Mahmoud Abdel Karim
- Trauma & Orthopaedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Hazem Farouk
- Trauma & Orthopaedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | | | - Ahmed Hazem Abdelazeem
- Trauma & Orthopaedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
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12
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Deng X, Liu J, Yang S, Wang X, Li Z. [Application of arthroscopic surgery combined with direct anterior approach in hip diseases]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1167-1171. [PMID: 30129333 DOI: 10.7507/1002-1892.201803115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the short-term effectiveness of arthroscopic surgery combined with direct anterior approach for hip diseases. Methods A retrospective study was performed on 23 cases with hip diseases (23 hips), who were treated with the arthroscopic surgery combined with direct anterior approach, between January 2015 and December 2016. There were 9 males and 14 females, aged from 27 to 49 years (mean, 38.6 years). There were 11 cases of posterior dislocation of the hip associated with femoral head fracture (Pipkin typeⅠ) and 7 cases of femoral neck fracture (Garden type Ⅳ). And the interval between injury and operation was 2-8 days (mean, 4.3 days). Five cases were osteonecrosis of femoral head at precollapse stage which were rated as stageⅡA according to Association Research Circulation Osseous (ARCO) classification system. The disease duration was 3-8 months (mean, 5.9 months). The preoperative Harris hip score, Oxford Hip Score (OHS), Postel score, and visual analogue scale (VAS) were 57.3±8.2, 11.2±3.6, 3.2±1.5, and 7.2±1.3, respectively. Results All the wounds healed primarily. Lateral femoral nerve injury occurred in 3 cases. All patients were followed up 8-19 months (mean, 15.6 months). Bone union achieved in all patients after 14-19 weeks (mean, 15.8 weeks) and no secondary osteoarthritis or heterotopic ossification occurred. At last follow-up, the Harris hip score (92.5±5.3), OHS (36.5±5.9), and Postel score (14.2±2.6) were significantly higher than preoperative scores (
t=45.274,
P=0.000;
t=36.586,
P=0.000;
t=32.486,
P=0.000), and VAS score (1.8±0.9) was significantly lower than preoperative score (
t=21.314,
P=0.000). Conclusion Arthroscopic surgery combined with direct anterior approach for hip diseases can effectively relieve pain, improve hip function, and obtain the satisfactory short-term effectiveness.
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Affiliation(s)
- Xiangtian Deng
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Juncai Liu
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Shuncheng Yang
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Xinyuan Wang
- Department of Oncology, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhong Li
- Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000,
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13
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Beals TR, Harris R, Auston DA. Articular Incongruity in the Lower Extremity: How Much Is Too Much? Orthop Clin North Am 2018; 49:167-180. [PMID: 29499818 DOI: 10.1016/j.ocl.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intraarticular fractures carry a significant risk for posttraumatic osteoarthritis, and this risk varies across different joint surfaces of the lower extremity. These differences are likely due to the anatomic and biomechanical specifics of each joint surface. High-quality human studies are lacking to delineate the threshold articular incongruity that significantly increases risk for posttraumatic osteoarthritis and diminished clinical outcomes for many joint surfaces. Even with anatomic reduction of the articular surface, close attention must be paid to mechanical axis and joint stability to optimize outcomes.
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Affiliation(s)
- Tim R Beals
- Jack Hughston Memorial Hospital, Department of Orthopedic Surgery, 4401 Riverchase Drive, Phenix City, AL 36867, USA
| | - Robert Harris
- Hughston Orthopedic Trauma at Midtown Medical Center, Jack Hughston Memorial Hospital, Department of Orthopedic Surgery, 4401 Riverchase Drive, Phenix City, AL 36867, USA
| | - Darryl A Auston
- Hughston Trauma at Orange Park Medical Center, 1895 Kingsley Avenue, Suite 300, Orange Park, FL 32073, USA.
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14
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Hüftgelenkarthroskopie bei Frakturen und Frakturfolgen. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Kekatpure A, Ahn T, Lee SJ, Jeong MY, Chang JS, Yoon PW. Arthroscopic Reduction and Internal Fixation for Pipkin Type I Femoral Head Fracture: Technical Note. Arthrosc Tech 2016; 5:e997-e1000. [PMID: 27909666 PMCID: PMC5123998 DOI: 10.1016/j.eats.2016.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/03/2016] [Indexed: 02/08/2023] Open
Abstract
Femoral head fractures after posterior dislocation of the hip are uncommon and are conventionally treated by an open method. Hip arthroscopy can be a valuable treatment option for the management of femoral head fractures. Arthroscopy allows for a less invasive option when compared with arthrotomy and can allow faster recovery with minimal soft-tissue injury. We describe the arthroscopic reduction and internal fixation of Pipkin type I femoral head fractures with a detailed stepwise description of the surgical technique, including technical pearls and pitfalls, potential complications, and advantages and disadvantages.
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Affiliation(s)
- Aditya Kekatpure
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Taesoo Ahn
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University, Boramae Hospital, Seoul, Republic of Korea
| | - Mi Youn Jeong
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,Address correspondence to Pil Whan Yoon, M.D., Ph.D., Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.Department of Orthopedic SurgeryAsan Medical CenterUniversity of Ulsan College of Medicine88, Olympic-Ro 43-GilSongpa-GuSeoul138-736Republic of Korea
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Lee A, O'Donnell J, Villar R, R Safran M. Hip arthroscopy: State of the Art. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Park JY, Chung WC, Kim CK, Huh SH, Kim SJ, Jung BH. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note. Hip Pelvis 2016; 28:120-6. [PMID: 27536654 PMCID: PMC4972886 DOI: 10.5371/hp.2016.28.2.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/12/2016] [Accepted: 04/28/2016] [Indexed: 11/24/2022] Open
Abstract
Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note.
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Affiliation(s)
- Jin Young Park
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Woo Chull Chung
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Che Keun Kim
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Soon Ho Huh
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Se Jin Kim
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Bo Hyun Jung
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
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Abstract
Traumatic hip dislocations are high-energy injuries that often result in considerable morbidity. Although appropriate management improves outcomes, associated hip pathology may complicate the recovery and lead to future disability and pain. Historically, open reduction has been the standard of care for treating hip dislocations that require surgical intervention. The use of hip arthroscopy to treat the sequelae and symptoms resulting from traumatic hip dislocations recently has increased, however. When used appropriately, hip arthroscopy is a safe, effective, and minimally invasive treatment option for intra-articular pathology secondary to traumatic hip dislocation.
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Niroopan G, de Sa D, MacDonald A, Burrow S, Larson CM, Ayeni OR. Hip Arthroscopy in Trauma: A Systematic Review of Indications, Efficacy, and Complications. Arthroscopy 2016; 32:692-703.e1. [PMID: 26935573 DOI: 10.1016/j.arthro.2015.12.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This systematic review explored the indications, efficacy, and complications of hip arthroscopy in the setting of trauma. METHODS Databases (PubMed, Medline, Embase, and Web of Science) were searched from database inception to March 2015 for studies using hip arthroscopy in trauma treatment. Systematic screening of eligible studies was undertaken in duplicate. The inclusion criteria included studies pertaining to arthroscopic intervention of all traumatic hip injuries. Abstracted data were organized in table format with descriptive statistics presented. RESULTS From an initial search yield of 2,809 studies, 32 studies (25 case reports and 7 case series) satisfied the criteria for inclusion. A total of 144 patients (age range, 10 to 53 years) underwent hip arthroscopy for 6 indications associated with trauma: 8 patients for bullet extraction, 6 for femoral head fixation, 82 for loose body removal, 6 for acetabular fracture fixation, 20 for labral intervention, and 23 for ligamentum teres debridement. Patients were followed up postoperatively for a mean of 2.9 years (range, 8 days to 16 years). Successful surgery was achieved in 96% of patients. The rate of major complications (i.e., pulmonary embolism and abdominal compartment syndrome) was 1.4% (2 of 144); avascular necrosis, 1.4% (2 of 144); and nerve palsy, 0.7% (1 of 144). CONCLUSIONS Hip arthroscopy appears effective and safe in the setting of trauma. These data should be interpreted with caution because of the low-quality evidence of the included studies. Surgeons should be aware of the potential complications such as abdominal compartment syndrome and thromboembolic events when performing hip arthroscopy in the setting of trauma. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Gavinn Niroopan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Austin MacDonald
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Burrow
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada.
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Affiliation(s)
- Geoffrey S Marecek
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, 1520 San Pablo, Suite 2000, Los Angeles, CA 90033
| | - John A Scolaro
- Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868
| | - Milton L Chip Routt
- University of Texas-Health Sciences Center at Houston, 6431 Fannin Street, Houston, TX 77030
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Newman JT, Saroki AJ, Philippon MJ. Hip arthroscopy for the management of trauma: a literature review. J Hip Preserv Surg 2015; 2:242-8. [PMID: 27011845 PMCID: PMC4765307 DOI: 10.1093/jhps/hnv047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/07/2015] [Accepted: 05/19/2015] [Indexed: 12/21/2022] Open
Abstract
The first descriptions of the use of hip arthroscopy for traumatic injuries were presented in 1980. One paper described arthroscopy for the removal of a bullet fragment while others reported using hip arthroscopy to remove fragments following total hip arthroplasty. With the application of traction and modification of arthroscopic instruments, hip arthroscopy has become a useful tool in treating trauma to the hip. Most of the literature describes traumatic hip dislocation. Several studies have documented the successful use of arthroscopy for removal of loose bodies, but it has also been used to treat labral tears, chondral defects and acetabular rim fractures. Complications reported include fluid extravasation, the lowering of the patient's body temperature using cool saline irrigation and further injury due to unrecognized concomitant pathology.
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Affiliation(s)
- Justin T Newman
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, CO, USA
| | - Adriana J Saroki
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, CO, USA
| | - Marc J Philippon
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, CO, USA
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