Surgical Dislocation or the Modified Heuter Anterior Approach for Pipkin I and II Femoral Head Fracture Dislocations

Abstract

Objectives: To compare outcomes after surgical treatment of Pipkin I and II femoral head fractures treated with either a surgical dislocation (SD) or a direct anterior approach (the modified Heuter approach). Study Design: Retrospective, multicentre. Setting: Three Level I trauma care centers. Patients: Fourty-nine patients operated for Pipkin types I or II femoral head fractures. Twenty-seven using SD and 22 using the modified Heuter approach. Interventions: Initial closed reduction of the joint followed by open reduction and internal fixation of the fracture/fragment excision. Fixation was performed using headless or countersunk mini fragment screws. Outcome Measurements: The 2 groups were compared for (1) perioperative measures: blood loss, surgical time, pain [visual analog scale (VAS)], and length of hospital stay; (2) radiological outcome in terms of fracture union, occurrence of posttraumatic hip arthritis, and femoral head osteonecrosis; and (3) functional outcome using the modified Merle d' Aubigne score and Oxford hip scores. Results: Surgical time, blood loss, and VAS at 24 hours were significantly lower in the modified Heuter group. The VAS at discharge and length of stay were similar in both groups. All fractures had united. No cases of osteonecrosis were observed. Functional outcome and complications were similar in both groups. Conclusions: Both SD and the modified Heuter approach are effective in treating patients with Pipkin I and II femoral head fractures with comparable radiological and functional outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Early versus delayed hip reduction in the surgical treatment of femoral head fracture combined with posterior hip dislocation: a comparative study

“…Although some studies have reported satisfactory results of nonsurgical treatment in patients with non-displaced Pipkin type I and type II fractures, this treatment has almost been abandoned because of the high rate of complications associated with longstanding patient immobility and the high cost of prolonged admission [ 1 , 6 – 9 ]. And more and more investigators recommend surgical treatment of femoral head fractures [ 1 – 3 , 8 , 10 – 13 ].…”

Management of a Pipkin Type III Femoral Head Fracture Via Ganz Approach with a Cannulated Lag Screw & Herbert Screw

“…However, in the presence of avascular necrosis of the femoral head, associated complications in using screw xation can only be avoided and reduced by improving the surgical technique applied. Current surgical approaches for femoral head fractures vary and include the medial approach (Ludloff approach) and the anterior approach (Smith Petersen approach), the antero-medial fenestration approach, the Watson-Jones Approach, the lateral approach and the Kocher-Langenbeck approach [13][14][15][16]. Despite these options, it remains a challenge to easily expose the femoral head and complete the reduction and xation under direct vision.…”