![]() ![]() There is still no consensus on the management of injuries, whether to treat these fractures operatively or non-operatively, whether to fix or excise the head fragment by open reduction or arthroscopically assisted or which surgical approach to use. ![]() Closed non-surgical treatment can be the approach for Pipkin type I and II fractures however, there is debate as to whether the treatment should be operative or non-operative. However, the optimal management strategy for femoral head fractures remains unclear. The common surgical approaches in practice include the Kocher–Langenbeck approach, Smith–Petersen approach, Hueter approach, Watson–Jones approach, the greater trochanter osteotomy approach, and the Ganz approach. Standard treatment strategies for the management of these injuries range from nonoperative treatment to fracture fragment excision or fracture fixation using various surgical approaches and implants. Pipkin type I involves the non-weight-bearing part of the femoral head, type II affects the weight-bearing part of the head of the femur, type III may include either or both types I or II with a femoral neck fracture, and type IV involves type I or II associated with an acetabular fracture. Pipkin categorized these injuries based on the location of the head fracture in relation to the fovea (Ligamentum Teres) and the associated lesions on the femoral neck or acetabulum. In 1957, Pipkin established a classification system that is most widely used to evaluate femoral head fractures. The most common mechanism is dashboard injury to the hip and lower extremities, which accounts for approximately 5–15% of posterior hip dislocations. These fractures are often the result of high-energy trauma due to road vehicle accidents (RTA). All participants provided written informed consent to participate in this study.įemoral head fractures are rare, but severe injuries with potentially significant long-term implications for patients. Our study was approved by the Clinical Research and Biomedical Ethical Committee of West China Hospital, Sichuan University, and was performed in accordance with the Declaration of Helsinki. This study, adds to the growing literature on femoral head fracture and provides a reference for the clinical treatment to guide patient management. The treatment aim should always be the anatomical reduction of the fragments. In this study, we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on the Pipkin classification. ![]() Conclusionįemoral head fractures are rare injuries often associated with poor outcomes. A statistically significant difference in outcome was observed among four pipkin subtypes. Overall functional results according to MHHS were, excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. Sixteen patients (33%) developed post-traumatic osteoarthritis (PTOA), eight (16%) developed heterotopic ossification (HO) and six patients (12%) had sciatic nerve injury, none requiring operative treatment. Six (12%) patients developed AVN, and four (8%) required a secondary THR. ResultsĮight (16%) patients were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, and 5 (10%) patients required immediate THR. The modified harris hip score (MHHS) was used to evaluate the ongoing complications with the clinical outcome of patients with two years or greater follow-up. The patients were also stratified by the Injury Severity Score (ISS), associated injuries, and, mechanism of injuries. The recorded surgical approach consists of an anterior(S-P) approach, posterior(K-L) approach, lateral stab, and combined anterior + lateral stab approach for fixation. Treatment methods were categorized into non-operative, operative by open reduction and internal fixation (ORIF), and immediate total hip replacement (THR). According to Pipkin’s classification, there were eighteen (36%) Pipkin I, ten (20%) Pipkin II, eight (16%) Pipkin III, and fourteen (28%) Pipkin IV patients. There were thirty-seven (74%) males and thirteen (26%) females with a median age of 40 years. We retrospectively reviewed 50 patients who sustained femoral head fractures between January 2011 and December 2018. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications, and functional outcomes of femoral head fractures. Femoral head fractures are rare injuries often associated with poor functional outcomes and complications. ![]()
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