Emergent Surgical Reduction and Fixation for Pipkin Type I Femoral Fractures

Lin, Dasheng; Lian, Kun; Chen, Zhiwen; Wang, Lei; Jian-ming, Hao; Zhang, Huantang

doi:10.3928/01477447-20130523-24

Cited by 21 publications

(15 citation statements)

References 14 publications

(11 reference statements)

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“…Swiontkowski et al [11] compared an anterior to posterior approach for the treatment of Pipkin I and II fractures in a retrospective case matched study. To the authors’ knowledge, only two limited randomized studies on the topic exist [12, 13]. Apart from a single systematic review on the topic [1], the largest contemporary series of femoral head fractures in the literature evaluated 110 patients from multiple centers and surgeons, over a period of 36 years; only 30 patients in this group were treated with femoral head ORIF [14].…”

Section: Discussionmentioning

confidence: 99%

Management and radiographic outcomes of femoral head fractures

et al. 2017

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Background Femoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center.Materials and methodsA retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis.ResultsWe identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision.ConclusionsFractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon.Level of evidenceIV—prognostic.

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Section: Discussionmentioning

confidence: 99%

Management and radiographic outcomes of femoral head fractures

et al. 2017

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“…The optimal timing of surgery is still controversial. Some literature indicated worse outcomes for Pipkin fractures with delayed surgery compared with those who had immediate surgery[ 13 ]. However, other studies showed no statistically significant differences in outcome when comparing time of surgery with hip reduction, definitive operative intervention or the anatomic operative approach to injury[ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Open reduction and Herbert screw fixation of Pipkin type IV femoral head fracture in an adolescent: A case report

Liu¹,

Dai²,

Wang³

et al. 2021

WJCC

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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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“…However, as for fracture larger than 1/3 of joint surface, it should be preserved and treated with internal fixation. Open reduction should be done as early as possible in Type-II since the fracture is always large in weight bearing area 14. The implants can be divided into metal screw and absorbable screw.…”

Section: Discussionmentioning

confidence: 99%

“…Open reduction should be done as early as possible in Type-II since the fracture is always large in weight bearing area. 14 The implants can be divided into metal screw and absorbable screw. The scholars who preferred absorbable screw believe that strength of absorbable screw is enough and the stress would be transferred to healing bone surface.…”

Section: Discussionmentioning

confidence: 99%

Clinical results of femoral head fracture-dislocation treated according to the Pipkin classification

Yu¹,

Pang²,

Chen³

2017

Pak J Med Sci

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Objective:To summarize the clinical results of femoral head fracture-dislocation treated according to Pipkin classification.Methods:Atotal of 19 patients with femoral head fracture-dislocation were retrospectively analyzed from Mar. 2008 to Mar. 2015. According to the classification of Pipkin criteria, there were 4 cases in Type-I, 6 cases in Type-II, 6 cases in Type-IIIand 3 cases in Type-IV. Various procedures were taken according to the different types of the fracture, the time of the fracture, and the age of the patients. X-ray was examined during the follow-up period and functional evaluation was carried out by Harris Hip Score’s criteria. The clinical therapeutic effects were analyzed.Results:All the patientsgot a mean follow-up of 18 months (9-36 months). No patient suffered from infection, skin flap necrosis and X-ray showed no implants loosening or breakage. According to the Harris Hip Score’s criteria, in Type-I, 4 cases were rated as excellent. In Type-II, 2 cases rated as excellent, 3 cases as good and 1 case as fair. In Type-III, 3 cases rated as good, 2 cases as fair and 1 case as poor. In Type-IV, 1 case rated as excellent, 1 case as good and 1 case as fair. The overall rate of excellent and good was 73.7%.Conclusions:Pipkin classification is helpful to make preoperative plan and judging the prognosis in cases of femoral head fracture-dislocation. However, multiple factors such as the time from injury to surgery, the ages of patients, the selection of implants should also be considered, which may affect the clinical results.

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Emergent Surgical Reduction and Fixation for Pipkin Type I Femoral Fractures

Cited by 21 publications

References 14 publications

Management and radiographic outcomes of femoral head fractures

Management and radiographic outcomes of femoral head fractures

Open reduction and Herbert screw fixation of Pipkin type IV femoral head fracture in an adolescent: A case report

Clinical results of femoral head fracture-dislocation treated according to the Pipkin classification

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