Clinical effects of direct anterior internal fixation with Herbert screws on hip joint function and quality of life in patients with Pipkin II femoral head fractures

Sun, Zhibo; Jiang, Liangbo; Chen, Rong; Zhao, Lin; Li, Xiangwei

doi:10.1007/s00402-021-03973-2

Cited by 3 publications

(3 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Group III (⅓) with screws had the longest retrospect with the highest percentage of THR (39–45%), but in the series examined ( 1 , 7 , 33 ), few cases were reduced and screwed, the approaches were not very suitable, the reductions were inadequate. However, it seems that reduction and screwing of this Chiron III type is the best solution, which is increasingly used thanks to the contribution of CT, compression screws and anterior or medial approaches ( 16 , 33 , 35 , 40 , 51 ). The existence of an associated posterior wall fracture is not a serious factor if the fractures are adequately reduced and osteosynthesised ( 1 , 7 , 52 ).…”

Section: Resultsmentioning

confidence: 99%

“…A displaced ¼ or ⅓ fragment after reduction can be resected ( 1 , 7 ) ( Fig. 10 ) or reduced/screwed ( 29 ); nowadays, screw osteosynthesis is done with Erberth-type double-compression pin-guided screws ( 30 , 33 , 34 , 35 , 36 ) ( Fig. 11 ); it may be wise to use resorbable screws.…”

Section: Secondary Treatmentmentioning

confidence: 99%

“…A posterior approach requires reluxation of the hip and provides reduced access to the lower, anterior part of the femoral head ( 38 ). An anterolateral or anterior approach provides better access ( 35 , 36 , 39 ). Ludloff medial approaches, modified by Ferguson ( 40 , 41 ), which pass between the adductor longus/brevis and magnus provide sufficient access for ablation or osteosynthesis, but the view is limited, the obturator nerve is in the line of approach.…”

Section: Secondary Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Dislocation fracture of the femoral head in adult

Chiron

Reina

2022

EFORT Open Reviews

View full text Add to dashboard Cite

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.

show abstract