Modified S-P approach and Ganz surgical dislocation for the treatment of Pipkin I-type fractures: a long-term retrospective study

Abstract

Background Posterior hip dislocation is the commonest type of hip dislocation. As it frequently combined fractures and may cause complications. Urgent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of the present study is to compare the clinical efficacy of the modified Smith-Peterson (mS-P) and Ganz surgical dislocation (GSD) in treating Pipkin I fractures. Methods A retrospective analysis of 23 patients diagnosed with Pipkin I femoral head fracture was conducted in Pidu District People's Hospital from June 2010 to May 2020. Regarding the treatment classification, 11 cases were treated with mS-P approach and 12 cases were treated with GSD approach. 1 case in each group lost the follow-up period in this study. The follow-up time of the rest 21 patients was 12–55 months, with an average of 37.7 months. Functional evaluation was done using the Thompson-Epstein Score, Modifed Harris Hip Score(MHHS), and Vail Hip Score (VHS) at final follow-up. The incision length, intraoperative time, intraoperative blood loss, intraoperative blood transfusion, length of stay in hospital, fracture healing time, and postoperative complications were also examined and compared between the two groups. Results According to the Thompson-Epstein function evaluation system, 6 patients (60%) had excellent results, 3 patients (30%) were rated as good, 1 patients (10%) as fair, and the excellent and good rate was 90% in mS-P group. And 3 patients (27.2%) had excellent results, 5 patients (45.5%) were rated as good, 2 patients (18.2%) as fair, 1 patient (9%) as poor and the rate of Excellent and Good results was 72.7% in GSD group. According to Harris hip score, 4 patients (40%) were rated as excellent, 2 patients (20%) as good; 4 patients (50%) as fair in mS-P group. Among cases of GSD group, 1 patient (9%) was rated as Excellent, 2 patients (18.2%) as good, 7 patients (63.6%) as fair and 1 patient (9%) as poor. According to VSH score, the average score of mS-P group was 82.3, and 74.4 in GSD group. Conclusions Both the mS-P and GSD approach can achieve a satisfactory result in surgical treatment of Pipkin I fractures. Open reduction and internal fixation(ORIF) of Pipkin I fractures using mS-P approach is more visual and less invasive than GSD approach, as well as less amount of bleeding. However, mS-P approach cannot provide satisfactory results with low occurrence of postoperative complications.