Fractures of the femoral head: a long-term follow-up study

Oransky, M; Martinelli, Nicolò; Sanzarello, Ilaria; Papapietro, Nicola

doi:10.1007/s12306-012-0182-7

Cited by 36 publications

(25 citation statements)

References 23 publications

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“…The scoring systems we used are Merle d'aubigne-postel and Thompson Epstein. With little modification of already established surgical dislocation of hip (see methods), we received clinically excellent outcome compared to the previous findings (40 -70% compared to 86% in this study) 5,9,10,12,15,16 .…”

Section: Discussionsupporting

confidence: 52%

“…Femur head fracture results from traumatic injury, and most frequently associated with posterior hip dislocation 10,13,15 . Available literature reported good or excellent outcome only in 40 to 70% of patients who underwent TFO therapy 5,9,10,15,12,16 . Herein, we adopted TFO therapeutic protocol for patients with femur head fracture with posterior hip dislocation and assessed the clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

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Use of Trochanteric Flip Osteotomy Improves the Outcome of Pipkin I and II Femoral Head Fractures

Dhakal¹,

Shrestha²,

Shrestha³

et al. 2018

J. Gandaki Med. Coll. Nepal

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Introduction: Annual incidence of femoral head fracture is constantly increasing due to increase in cases of road traffic accidents (RTA). Four to 17% of femoral head fractures are due to posterior dislocations of hip. Outcome of femoral head facture associated with posterior dislocation of hip, the pipkin I and II fracture, is unsatisfactory due to lack of universally accepted protocol for its management and treatment. Objective: To evaluate the patient outcome using relatively newer approach, the Trochanteric Flip (digastrics) Osteotomy (TFO), for the precise anatomical reduction of femoral head fractures associated with posterior dislocation of hip. Methods: Between 2013 and 2017, 21 patients with sustained isolated femoral head fracture were admitted at our hospital. We used TFO approach for the management and treatment of femoral head fractures. The patients were followed up for 42 months at different intervals. Clinical outcome were evaluated using Merle d’Aubigne Postel and Thompson-Epstein scale. Results: Retrospective analysis showed excellent, good, fair and poor results in five (23.8%) patients, 13 (61.9%) patients, two (9.5%) patients and one (4.7%) patient, respectively. Clinical outcomes included sciatic nerve injury (4.7%), moderate arthritis (95.3%), benign non-debilitating heterotrophic ossification (19%), avascular necrosis of femoral head (4.7%) and neuropraxia (4.7%). Conclusions: Use of trochanteric flip osteotomy gives the favorable outcome for the treatment of this type of fracture. Most importantly, the vascularity of femoral head remains intact which makes TFO a very useful technique for pipkin I and II fracture treatment.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Use of Trochanteric Flip Osteotomy Improves the Outcome of Pipkin I and II Femoral Head Fractures

Dhakal¹,

Shrestha²,

Shrestha³

et al. 2018

J. Gandaki Med. Coll. Nepal

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“…Although indications for surgical management are quite clear, controversies still remain regarding the treatment of Pipkin type I and type II femoral head fractures, preferred surgical approach and whether to perform fixation or excision of the fracture fragment [7]. The principles of treatment include prompt reduction of the associated hip dislocation, early anatomic reduction, rigid fixation of large fragments, restoration of hip congruency and stability and removal of small and comminuted intra-articular fragments [8].…”

Section: Discussionmentioning

confidence: 99%

Application of Trochanteric Flip Osteotomy with Herbert Screw to Treat Pipkin I,II Fracture of the Femoral Head

Sun¹

2016

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There is no definite protocol in management of Pipkin fracture in relation to operation approach and internal fixations. The aim is to explore the therapeutic effects of internal fixation with Herbert screws for the treatment of Pipkin type I and type II femoral head fractures through the trochanteric flip osteotomy (TFO) approach. From January 2010 to December 2014, 12 cases of type I and II Pipkin fracture (including 8 type I,4 type II) treated through TFO approach and internal fixation with Herbert screws. All the patients were followed up 1-4 years with an average of 2.6 years. The whole osteotomies and acetabular fractures healed within 6 to 12 weeks. All patients achieved healing of femoral head fracture after 12-16 months without femoral head necrosis. Heterotopic ossification (HO) occurred in 1 cases after operation which were left untreated. At the last follow-up, excellent and good rate was 91.7%. Treatment of type I, II Pipkin fracture through TFO approach can provide good visualization and protect of the femoral head blood supply. The treatment of internal fixation with Herbert screws is effective for Pipkin type I and type II femoral head fracture.

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“…Indeed, Kelly and Lipscomb reported a frequency of 2 cases of femoral head fractures per million people per year. Although high‐speed motor vehicles and industrial advances have led to an increase in the incidence of femoral head fractures, it is still a rare injury. The most common cause of femoral head fractures is high‐energy traffic accidents; the incidence reported by Pipkin was approximately 92% (23/25), while Kelly and Yarbrough reported an incidence of 92.6% (25/27).…”

Section: Introductionmentioning

confidence: 99%

In Situ Reduction and Fixation of the Anterior Medial Fenestration Approach for Femoral Head Fracture

Wang

Zhao

et al. 2019

Orthopaedic Surgery

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ObjectiveTo investigate the feasibility and clinical application of the anterior medial fenestration approach in the treatment of Pipkin type I and II femoral head fractures.MethodsThe hips of two anti‐corrosion adult specimens treated with formalin were dissected and the anatomical structures and directional characteristics of the anterior medial main muscles, ligaments, blood vessels, and nerves were observed. The anterior medial fenestration approach was performed on bilateral hips of four fresh frozen specimens to determine the required pulling direction of the stripped muscles and ligaments during surgery. In addition, the vascular and nerve traction protection directions exposed in the approach were observed and analyzed. The feasibility of this approach was assessed, and the operative approach and critical anatomical depth were measured. We retrospectively analyzed 12 patients with Pipkin type I and II femoral head fractures who underwent in situ reduction and fixation by anterior medial fenestration in our hospital from February 2016 to April 2018. The study group included 3 men and 9 women aged 37–59 years (mean, 48.50 years). There were 8 cases of Pipkin type I and 4 cases of Pipkin type II. The operation time, blood loss, fracture healing time, last Thompson–Epstein evaluation, and Harris score were recorded.ResultsA total of 8 fresh frozen specimens from 4 bilateral hips were exposed by anterior medial fenestration. The upper boundary of observation fenestration was the pubic body (anterior acetabulum), and the outer upper boundary was the iliacus and the psoas muscle. The lateral boundary was the rectus femoris and the femoral vessels, while the lower boundary was the transverse branch of the medial femoral circumflex artery and vein. The medial boundary was the pubis muscle, the short adductor muscle, and the long adductor muscle. The pubofemoral and iliofemoral ligaments were observed during fenestration. By cutting open the joint capsule and moving the hip joint, the four quadrants of the femoral head can be exposed. Twelve patients with femoral head fractures who were treated with anterior medial fenestration underwent in situ reduction and fixation. The operation time was 96.25–118.75 min (median, 100 min), and the blood loss was 115.00 ± 22.76 mL. The follow‐up time was 18.58 ± 4.48 months, and the fracture healing time was 144.17 ± 14.53 days. The last Thompson–Epstein evaluation was excellent in 6 cases, good in 4 cases, and fair in 2 cases; the excellent and good rate was 83.33%. Finally, the last Harris score was 85.08 ± 5.73 points.ConclusionsThe upper and lower boundaries, inner and outer boundaries, and rear anatomical structure of the anterior medial fenestration approach were defined. The movable hip joint can expose the four quadrants in front of the femoral head in this fenestration. Anterior medial fenestration in situ reduction and fixation surgery is feasible and safe for the treatment of Pipkin type I and II femoral head fractures.

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Fractures of the femoral head: a long-term follow-up study

Cited by 36 publications

References 23 publications

Use of Trochanteric Flip Osteotomy Improves the Outcome of Pipkin I and II Femoral Head Fractures

Use of Trochanteric Flip Osteotomy Improves the Outcome of Pipkin I and II Femoral Head Fractures

Application of Trochanteric Flip Osteotomy with Herbert Screw to Treat Pipkin I,II Fracture of the Femoral Head

In Situ Reduction and Fixation of the Anterior Medial Fenestration Approach for Femoral Head Fracture

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