Management of femoral head fracture by Ganz surgical dislocation of the hip

Abstract

Introduction Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture. Patients and methods In this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta’s criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d’Aubigne and Postel score at final follow-up. Results No patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta’s criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d’Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results. Conclusion Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate.

Articular Femoral Head Fracture Management: A Comprehensive Systematic Review

“…Hosny, H et al (2022) 10 showed open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rates.…”

CORR Insights®: Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

“…In one study, complications such as heterotopic ossification and avascular necrosis were found to occur in 43% and 23% of patients, respectively, and femoral head fractures were treated with open reduction and internal fixation without surgical hip dislocation [6]. Hosny et al [3] proposed using the Ganz surgical hip dislocation technique for Pipkin Type I and II femoral head fractures, which led to only 1 in 18 patients having avascular necrosis at 2-year follow-up. Future research may demonstrate that the Ganz technique is most useful for Pipkin I femoral head fractures but not Pipkin IV femoral head fractures.…”