General principles for treatment of femoral head fractures

Giordano, Vincenzo; Giordano, Mario; Glória, Renato Caravellos; Souza, Felipe Serrão de; Tullio, Paulo Di; Lages, Marco Martins; Koch, Hilton Augusto

doi:10.1016/j.jcot.2017.07.013

Cited by 41 publications

(47 citation statements)

References 25 publications

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“…Approximately two thirds of patients were young adults, occurring in as many as 75% of the cases [6]. About 5~15% of posterior hip dislocations have been reported to be associated with femoral head fractures [7]. The most widely used classification was that of Pipkin [5] which was based on the location of the femoral head fracture in relation to the fovea and additional lesion on the femoral neck or acetabulum as shown in Fig.…”

Section: Introductionmentioning

confidence: 99%

3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

et al. 2019

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BackgroundFemoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity.Patients and methodsBetween 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d’Aubigne scores. The reduction of the fracture was evaluated according to Matta’s criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented.ResultsTwelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25–48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d’ Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1).ConclusionsThe 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively redu...

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Section: Introductionmentioning

confidence: 99%

3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

et al. 2019

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“…Statistical analyses were done in SPSSV. 16. Descriptive variables were presented as Mean±SD for numerical variables and number and percentage for categorical variables.…”

Section: Discussionmentioning

confidence: 99%

“…There is no concrete information about many aspects of femoral head fracture, including optimal management, outcomes, and complications [16][17][18][19][20]. As a general rule, Open Reduction and Internal Fixation (ORIF) is the treatment of choice for most patients with femoral head fracture.…”

Section: Discussionmentioning

confidence: 99%

The Outcome of Treatment of Femural Head Fracture: A Single-Center Retrospective Study

Yeganeh

Farahini

Hajializade

et al. 2020

J. Res. Orthop. Sci.

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Background: There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies. Objectives: In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm. Methods: In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation). Results: Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071). Conclusion: The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome.

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“…[ 11 – 14 ] Open reduction and internal fixation is preferable when there is a nonconcentric hip reduction. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

Closed reduction of the traumatic posterior-dislocation of hip joint using a novel sitting technique

et al. 2018

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Rationale:Traumatic hip dislocation is a common joint dislocation. Delayed reduction has been shown to increase the risk of avascular necrosis of the femoral head. Most of the traditional methods must be performed under general anesthesia or spinal anesthesia to relax hip muscles. Anesthesia will prolong the interval between the injury and the reduction.Patient concerns:16 patients presented with hip pain and a leg shortened, flexed, internally rotated and adducted.Diagnoses:X-ray and CT-scan showed acute closed posterior dislocation of hip.Interventions:Closed reduction of the traumatic posterior-dislocation of hip joint using a novel sitting technique.Outcomes:Among these 16 patients, 15 hips were successfully reduced using the Sitting Technique (table 1), indicating the success rate was 93.8%(15/16). A total of 12 patients were followed up, with a mean period of 23.5 months (range, 6–72 months). Among these 12 patients, 10 patients (83.3%) had excellent grade, 2 patients (16.7%) had good grade.Lessons:Sitting technique for treatment of traumatic posterior dislocation of hip joint does not need anaesthesia, which it shortens the interval between the injury and the reduction and saves valuable time for 6 hours of joint reduction. On the other hand, this method does no harm to the physicians’ low back.

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General principles for treatment of femoral head fractures

Cited by 41 publications

References 25 publications

3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

The Outcome of Treatment of Femural Head Fracture: A Single-Center Retrospective Study

Closed reduction of the traumatic posterior-dislocation of hip joint using a novel sitting technique

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