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

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.

Fractured morphology of femoral head associated with subsequent femoral neck fracture: Injury analyses of 2D and 3D models of femoral head fractures with computed tomography

“…FHFs were rare but serious injuries caused by highenergy trauma (Alonso et al, 2000). A CT scan of the hips was needed for better diagnosis and treatment of the fractures (De Mauro et al, 2021). The CT scan helped understand features of FHF, including the femoral head fracture pattern, the congruity of the hip joint, and the presence or absence of intra-articular loose fragments, which may not Frontiers in Bioengineering and Biotechnology frontiersin.org be accurately detected in X-ray image (Ross and Gardner, 2012).…”

Surgical treatment and functional outcome of bilateral symmetrical hip dislocation and Pipkin type II femoral head fracture: a 5-year follow-up case report and literature review

“…Various operative approaches have been opted for Pipkin fractures depending on the femoral head fragment, the direction of the dislocation, and the associated acetabular fractures. Several types of approaches are described in the literature: posterior (Kocher-Langenbeck), posterolateral (Moor), anterolateral (Watson Jones), trochanteric flip osteotomy, Gibson surgical hip dislocation, and direct anterior approach (Smith-Peterson) (24,25). Our preference is for DAA, which is also interchangeably called modified Hunter's anterior surgical approach or Smith-Peterson to treat bilateral Pipkin type II justifying the minimally invasive, adequate exposure for femoral head fixation, surgical positioning in the supine position, short hospital stays and rapid recovery of incision wounds.…”

Spring Plates as a Valid Additional Fixation in Comminuted Posterior Wall Acetabular Fractures: A Retrospective Multicenter Study

“…For the study aims, all the posterior wall acetabular fractures between February 2018 and February 2020 who underwent internal fixation with the use of spring plate (DePuy Synthes, West Chester, PA, USA) were included. Patients with incomplete data, follow-up shorter than 24 months, pathological fractures of the acetabulum, associated femoral head fractures [ 14 ], history of homolateral acetabular fractures were excluded. Diagnosis was made according to the Judet and Letournel classification, on plain radiographs in antero-posterior view and Judet views, iliac and obturator oblique views, and thin-slice CT with multiplanar reconstructions ( Figure 1 ).…”