Surgical treatment of femoral head fractures through previously controlled hip luxation: four case series and literature review

Stirma, Guilherme Augusto; Uliana, Christiano Saliba; Valenza, Weverley Rubele; Abagge, Marcelo

doi:10.1016/j.rboe.2018.03.013

Cited by 5 publications

(6 citation statements)

References 6 publications

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“…Matta’s criteria for radiological evaluation of fracture reduction were reported in three studies [ 4 , 14 , 22 ] as well as the current study. Functional outcome can be evaluated either by Harris Hip Score [ 4 , 8 , 14 , 28 ] or Merle d’Aubigne and Postel score [ 2 , 3 , 5 , 6 , 14 , 22 ]. We used both Harris Hip Score and Merle d’Aubigne and Postel score for functional evaluation of our cases.…”

Section: Discussionmentioning

confidence: 99%

“…Delayed diagnosis inevitably leads to poor prognosis and irreversible complications that may eventually require hip joint arthroplasty [ 1 ]. Because of the infrequency of femoral head fracture, few studies are available, and often with only a small number of patients [ 1 – 8 ]. The association of femoral head fracture and hip dislocation was first described in 1869 by Birkett [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Reinhold Ganz described a surgical hip dislocation technique and reported no osteonecrosis in his case series [ 13 ]. Few literature studies describe the technique of surgical hip dislocation [ 1 , 2 , 4 – 6 , 8 , 14 ]. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Hosny

2022

J Orthop Traumatol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hosny

2022

J Orthop Traumatol

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“…The three major reported complications after FHF management had been alternating between AVN of the femoral head, HO formation, and posttraumatic OA as reported in many studies regardless of the approach used for surgery[ 1 - 3 , 25 ]. Controversy exists as to whether the trauma incident itself or the surgical intervention (including the surgical approach) is the cause leading to these complications; for example, the timing of reduction (if the patient presented with a dislocated hip) could affect the complication incidence[ 8 , 11 , 31 ], and disruption of the femoral head vascularity (leading to AVN) can occur at the time of trauma rather than being a consequence of surgical intervention[ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis

Khalifa¹,

Haridy²,

Fergany³

2021

WJO

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BACKGROUND Femoral head fractures (FHFs) are considered relatively uncommon injuries; however, open reduction and internal fixation is preferred for most displaced fractures. Several surgical approaches had been utilized with controversial results; surgical hip dislocation (SHD) is among these approaches, with the reputation of being demanding and leading to higher complication rates. AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature. METHODS Major databases including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs. We extracted basic studies data, surgery-related data, functional outcomes, radiological outcomes, and postoperative complications. We calculated the mean differences for continuous data with 95% confidence intervals for each outcome and the odds ratio with 95% confidence intervals for binary outcomes. P < 0.05 was considered significant. RESULTS Our search retrieved nine studies meeting our inclusion criteria, with a total of 129 FHFs. The results of our analysis revealed that the average operation time was 123.74 min, while the average blood loss was 491.89 mL. After an average follow-up of 38.4 mo, a satisfactory clinical outcome was achieved in 85% of patients, with 74% obtained anatomical fracture reduction. Overall complication rate ranged from 30% to 86%, with avascular necrosis, heterotopic ossification, and osteoarthritis being the most common complications occurring at an incidence of 12%, 25%, and 16%, respectively. Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4% and 3.8%, respectively. CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis, the formation of heterotopic ossification, and the development of posttraumatic osteoarthritis; however, it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.

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“…Avascular necrosis (AVN) of the femoral head is one of the major complications after FHFs; however, this complication could occur due to damage to the main nutrient artery at the time of trauma or by surgical intervention, the incidence reported in the literature ranges from 7% to 24% independent of the approach. 63 , 64 …”

Section: Anterior Medial Fenestration Approachmentioning

confidence: 99%