Safety of surgical hip dislocation in femoral head fracture and dislocation (FHFD) and avascular necrosis risk factor analysis of FHFD: midterm results confirmed by SPECT/CT and MRI

Abstract

Background The study aim was to report the treatment outcomes of trochanteric flip osteotomy (TFO) with surgical hip dislocation (SHD) for femoral head fracture and dislocation (FHFD) and to investigate the risk factors for avascular necrosis (AVN) of the femoral head. Methods The data of 34 patients (29 men, 5 women; mean age 37.9 years) diagnosed with FHFD and treated with TFO with SHD between May 2009 and February 2018 with an average follow-up period of 5.1 years (range 2.8–10.5 years) were analyzed. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score and Thompson–Epstein Scale. Radiologic outcomes were classified according to the Matta classification. AVN was confirmed using magnetic resonance imaging or single-photon emission computed tomography/computed tomography. The occurrence of complications was examined, and factors influencing complications, AVN. Results Regarding the Pipkin’s classification, there were 7 patients with type II, 2 patients with type III, and 25 patients with type IV fractures. Posterior wall fractures accompanied all associated acetabular fractures in the patients with Pipkin type IV fractures. Radiologically, the union of acetabular and femoral head fractures was observed within 6.1 months on average (range 4–10 months) in 32 patients, except two patients who developed femoral head AVN. Clinically, the average Merle d'Aubigné–Postel score was 14.4 points (range 8–17 points), and 22 patients had good or excellent results on the Thompson–Epstein Scale. Two patients developed femoral head AVN with both having displaced femoral neck fractures associated with FHFD. AVN was significantly correlated with femoral neck fractures (P = 0.000). Conclusion TFO with SHD is a safe and useful approach for the treatment of FHFD. Particular attention should be paid when treating femoral head fractures associated with displaced femoral neck fractures because of the high risk of AVN development.

Articular Femoral Head Fracture Management: A Comprehensive Systematic Review

“…Yoon, YC et al (2022) 11 showed TFO with SHD is a safe and useful approach for the treatment of FHFD. Particular attention should be paid when treating femoral head fractures associated with displaced femoral neck fractures because of the high risk of AVN development.…”

Management and outcome of patients with femoral head fractures: the mid-term follow-up with injuries and associated prognostic factors

“…Currently, in clinical practice, there is no routine examination to assess the blood flow of the femoral head after a Pipkin fracture, except for MRI, for the diagnosis of AVN. Recent studies have quantified the blood flow and perfusion status of the femoral head after hip fracture using single-photon emission computed tomography (SPECT) with computed tomography (CT) to evaluate the blood flow status in the bone while precisely localizing the necrotic site [ 47 – 49 ]. We recommend initiating the trend to judge the blood flow status with axillary examination with SPECT or PET-CT to predict osteonecrosis of the femoral head even after implant insertion after surgical or non-surgical management of Pipkin fractures.…”

Etiology, pathology, and treatment of osteonecrosis of the femoral head in adolescents: A comprehensive review

“…During the examination of avascular necrosis of the femoral head by MRI, high resolution of soft tissue can be produced, and bone marrow edema, necrosis and granulation infiltration can be clearly displayed. [ 28 , 29 ] According to the relevant meta-analysis, the diagnosis rate of avascular necrosis of the femoral head by MRI was higher than that by X-ray and CT. [ 30 ]…”