Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

Wang, Shanxi; Li, Bo-Hua; Li, Jun; Huang, Fuguo; Xiang, Zhou; Zhong, Gang; Fang, Yue; Yi, Min; Zhao, Xiaodan; Liu, Lei

doi:10.1016/j.cjtee.2017.12.004

Cited by 15 publications

(22 citation statements)

References 34 publications

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“…Five of 20 cases (25%) required THR during the follow-up period. This result is in agreement with the literature, as a THR rate of 5-33% after Pipkin type IV FH fractures is generally reported [9,11,26,28,32].…”

Section: Several Methods Of Surgical Dislocation Of the Hip Have Beensupporting

confidence: 93%

“…Table 2 summarizes the major case series studies of patients with Pipkin type IV FH fractures. Nevertheless, some previous investigators included nonoperative populations [26,27], and some surgeons used a single approach [9,11,28]. The rarity of Pipkin type IV fractures makes comparative studies difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Prophylaxis was not administrated in our series due to the concern of fracture nonunion, and the results revealed a low incidence of HO (5%, only one out of 20 cases). We postulated that the incidence of HO may be related to racial differences, as most investigations which report a high incidence of HO were conducted in western countries [9][10][11]15], while low incidence has been reported for studies conducted in Asian countries [25,28].…”

Section: Several Methods Of Surgical Dislocation Of the Hip Have Beenmentioning

confidence: 99%

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Modified Hardinge approach is an alternative to trochanteric flip osteotomy for Pipkin type IV femoral head fracture

Chen¹,

Chou²,

Hsu³

et al. 2019

Preprint

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Background Pipkin type IV femoral head (FH) fractures generally have poor prognoses. Although several surgical approaches are used, the optimal procedure is still under debate. The purposes of this study were to compare two approaches, the modified Hardinge approach and trochanteric flip osteotomy, for the treatment of Pipkin type IV FH fractures. Methods This retrospective study included 20 patients who underwent surgical treatment for Pipkin type IV FH fractures between January 2011 and September 2017 at a level 1 trauma center. Thirteen were treated using the modified Hardinge approach (group A) and seven with trochanteric flip osteotomy (group B). All patients completed at least 1 year of follow-up. The clinical outcome of the Merle d’Aubigné-Postel score; and radiological outcomes including the quality of the fracture reduction, the osteonecrosis of the FH (ONFH), the hip joint osteoarthritis (OA), and heterotopic ossification (HO); were compared between the two groups. Conversion to THR was also recorded as an outcome measure, analyzed by Kaplan–Meier curve and log-rank test. Results The mean operative time was similar in the two groups. The estimated blood loss of group B (435.7 ± 307.8 ml) was nearly double that of group A (233.1 ± 116.8 ml), although not statistically significant (P = 0.135). Radiographic outcomes including the quality of fracture reduction, ONFH, hip joint OA, and HO did not differ significantly between the two groups. There were also no significant differences between the two groups in terms of mean Merle d’Aubigné-Postel score at 1 year after injury and the log rank test of conversion to THR. One patient in group A had recurrent dislocation and underwent revision surgery, while one patient in group B requested removal of the trochanteric screws due to discomfort. Conclusions For the management of Pipkin type IV FH fractures, the modified Hardinge approach results in reduced blood loss, similar clinical and radiological outcomes compared with trochanteric osteotomy. The modified Hardinge approach appears to be an acceptable alternative to trochanteric flip osteotomy.

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Section: Several Methods Of Surgical Dislocation Of the Hip Have Beensupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Several Methods Of Surgical Dislocation Of the Hip Have Beenmentioning

confidence: 99%

See 1 more Smart Citation

Modified Hardinge approach is an alternative to trochanteric flip osteotomy for Pipkin type IV femoral head fracture

Chen¹,

Chou²,

Hsu³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…If a single-incision or the transtrochanteric approach with trochanteric osteotomy were employed, the capsule would still need to be incised and the FH dislocated [ 10 , 11 , 25 , 26 ]. All these procedures may potentially further disrupt the vascular arcade comorbidity due to extensive soft-tissue damage, which will lead to the occurrence of the osteonecrosis of femoral head (ONFH) or heterotopic ossification (HO) [ 12 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of type IV Pipkin fracture in patients with a high BMI via hip arthroscopy-assisted surgery: a case report

Hsu

Chen

Hsu

2020

Journal of Hip Preservation Surgery

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Pipkin type IV femoral head (FH) fracture–dislocations are usually treated via open surgery. There are many surgical approaches for the treatment of this difficult fracture depending on the fracture pattern. Obesity presents another challenging problem in surgical treatment and sometimes leads to a poorer outcome. We discuss herein a patient of a high body mass index (BMI) with a Pipkin type IV FH fracture who underwent open reduction internal fixation (ORIF) of anacetabular fracture with reconstruction plates and hip arthroscopy-assisted fixation of the FH fracture with two Herbert screws via the posterior approach. The intra-articular osteochondral loose bodies were excised by hip arthroscopy simultaneously. The joint congruency and screw positions were checked during surgery by arthroscopy. After 6 months, clinical and computed tomography (CT) follow-ups showed excellent results. The patient of a high BMI recovered immediately and had a satisfactory short-term outcome after hip arthroscopy-assisted surgery. We concluded that hip arthroscopy-assisted surgery is a viable option for the treatment of Pipkin type IV FH fracture–dislocations.

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“…In cases of femoral head fractures combine with posterior hip dislocation, the early and prompt hip reduction is associated with a good results [1,2,10,11]. However, because of the the relatively infrequent and limited numbers of patients, there is still no consensus on the reduction timing of posterior hip dislocation in treating femoral head fracture-dislocations [2,12].…”

Section: Introductionmentioning

confidence: 99%

Early Versus Delayed Hip Reduction in Treating Femoral Head Fracture Combined With Posterior Hip Dislocation: A Comparative Study

Wang¹,

Li²,

Zhang³

et al. 2021

Preprint

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Background: Few studies focus on the treatment of femoral head fracture combined with posterior hip dislocation, and the the safe interval time between injury and reduction still remains controversial. The purpose of this study was to evaluate and compare the outcome of early and delayed hip reduction in treating femoral head fracture combined with posterior hip dislocation. Methods: A total of 71 patients were evaluated in this retrospective study. Based on the time to hip reduction, they were divided into early group (within 6 hours after injury) and delayed group (between 6 - 12 hours after injury). The two groups were compared in reference to hospital day, fracture healing time, the occurrence of complications and final functional outcome. The Thompson-Epstein criteria, modified merled’ Aubigne-Postel scores, visual analog scale (VAS) and Medical Outcomes Short Form 12-item questionnaire score (SF-12) were used for final functional evaluation.Results: The mean hospital day and fracture healing time in the early group were significantly lower than delayed group. The incidence of infection, post-traumatic osteoarthritis, and avascular necrosis of the femoral head (ANFH) in the delayed group were higher than early group. The early group had better functional outcomes in term of Thompson-Epstein criteria, modified merled’ Aubigne-Postel scores and physical component scale (PCS) than delayed group. Conclusions: For the treatment of femoral head fracture combined with posterior hip dislocation, the early and prompt hip reduction can effectively facilitate the fracture healing and patient recovery as well as obtain better functional outcomes.

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Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

Cited by 15 publications

References 34 publications

Modified Hardinge approach is an alternative to trochanteric flip osteotomy for Pipkin type IV femoral head fracture

Modified Hardinge approach is an alternative to trochanteric flip osteotomy for Pipkin type IV femoral head fracture

Treatment of type IV Pipkin fracture in patients with a high BMI via hip arthroscopy-assisted surgery: a case report

Early Versus Delayed Hip Reduction in Treating Femoral Head Fracture Combined With Posterior Hip Dislocation: A Comparative Study

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