SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANGYanfeng , LIUYouwen , ZHUYingjie , LIJianming ,  LIWuyin , LIQiyi , JIAYudong

Department of Hip Injury, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang Henan, 471002, P. R. China;

Corresponding author：

LIWuyin, Email: yjstyf@126.com

Keywords：

Femoral head fracture; Hip dislocation; Operative approach

DOI：

10.7507/1002-1892.20150287

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Objective To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. Methods A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type Ⅰ, 7 cases as type Ⅱ, 1 case as type Ⅲ, and 5 cases as type Ⅳ. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. Results Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms[staging as Ⅱa and Ⅱb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage Ⅲb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade Ⅰ, 1 case of grade Ⅱ, and 1 case of grade Ⅲ based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. Conclusion Surgical hip dislocation approach can not only protect the residual vessels of the femoral head but also fully expose the acetabulum and femoral head, which is the ideal approach for the treatment of femoral head fractures.

Citation： TANGYanfeng, LIUYouwen, ZHUYingjie, LIJianming, LIWuyin, LIQiyi, JIAYudong. SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1327-1331. doi: 10.7507/1002-1892.20150287 Copy

1.	Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12):1245-1251.
2.	Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to femoral hean and acctabulum without the risk of avascular necrosis. J Bone Joint Surg (Br), 2001, 83(8):1119-1124.
3.	张洪, 邹吉杨, 肖凯. 髋关节外科脱位-髋关节内手术的基本手术入路. 中华外科杂志, 2014, 52(12):915-918.
4.	Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twentyone years. J Bone Joint Surg (Am), 1951, 33(3):746-778.
5.	孙大铭, 张洪. 髋关节外科脱位:充分、安全的髋关节显露. 中国骨肿瘤骨病, 2011, 10(5):464-467.
6.	叶少腾, 陈凯宁, 陈嘉欣, 等. 髋关节外侧入路在Pipkin骨折治疗中的应用. 中华创伤骨科杂志, 2010, 12(1):31-34.
7.	Epstein HC. Posterior fracture dislocations of the hip:long lerm follow-up. J Bone Joint Surg Br (Am), 1974, 56(6):1103-1127.
8.	陈志伟, 戴祝, 廖英, 等. 经转子入路大转子截骨治疗Ⅳ型Pipkin骨折. 中国修复重建外科杂志, 2011, 25(10):1184-1187.
9.	Rose JR, Gardner MJ. Femoral head fractures. Curr Rev Musculoskelet Med, 2012, 5(3):199-205.
10.	Stannard JP, Harris HW, Volgas DA, et al. Functional outcome of patiens with femoral herad fractures associated with hip dislocations. Clin Orthop Relat Res, 2000, (377):44-56.
11.	Massè A, Aprato A, Alluto C, et al. Surgical hip dislocation is a reliable approach for treatment of femoral head fractures. Clin Orthop Relat Res, 2015.[Epub ahead of print].
12.	Masse A, Aprato A, Rollero L, et al. Surgical dislocation technique for the treatment of acetabular fractures. Clin Orthop Relat Res, 2013, 471(12):4056-4064.
13.	Gardner MJ, Suk M, Pearle A, et al. Surgical dislocation of the hip for fractures of the femoral head. J Orthop Trauma, 2005, 19(5):334-342.
14.	Bastian JD, Büchler L, Meyer DC, et al. Surgical hip dislocation for osteochondral transplantation as a salvage prodecure for a femoral head impaction fracture. J Orthop Trauma, 2010, 24(12):e113-118.
15.	Keel M, Eid K, Isler B, et al. The role of surgical hip dislocation in the treatment of acetabular and femoral head fractures. Eur J Traumar Emerg Surg, 2005, 30(2):138-147.
16.	Kim JW, Chang JS, Bae JY, et al. Outcomes of treatment for femoral head fractures with hip dislocation-review of 20 cases. J Korean Hip Soc, 2010, 22(4):298-304.
17.	Mostafa MF, El-Adl W, El-Sayed MA. Operative treatment of displaced Pipkin type Ⅰ and Ⅱ femoral head fractures. Arch Orthop Trauma Surg, 2014, 134(5):637-644.
18.	Gagala J, Tarczyńska M, Gaweda K. Fixation of femoral head fractures with antologous osteochondral transfer (mosaicplasty). J Orthop Trauma, 2014, 28(9):226-230.
19.	Henle P, Kloen P, Siebenrock KA. Femoral head injuries:Which treatment strategy can be recommended? Injure, 2007, 38(4):478-488.

1. Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12):1245-1251.
2. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to femoral hean and acctabulum without the risk of avascular necrosis. J Bone Joint Surg (Br), 2001, 83(8):1119-1124.
3. 张洪, 邹吉杨, 肖凯. 髋关节外科脱位-髋关节内手术的基本手术入路. 中华外科杂志, 2014, 52(12):915-918.
4. Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twentyone years. J Bone Joint Surg (Am), 1951, 33(3):746-778.
5. 孙大铭, 张洪. 髋关节外科脱位:充分、安全的髋关节显露. 中国骨肿瘤骨病, 2011, 10(5):464-467.
6. 叶少腾, 陈凯宁, 陈嘉欣, 等. 髋关节外侧入路在Pipkin骨折治疗中的应用. 中华创伤骨科杂志, 2010, 12(1):31-34.
7. Epstein HC. Posterior fracture dislocations of the hip:long lerm follow-up. J Bone Joint Surg Br (Am), 1974, 56(6):1103-1127.
8. 陈志伟, 戴祝, 廖英, 等. 经转子入路大转子截骨治疗Ⅳ型Pipkin骨折. 中国修复重建外科杂志, 2011, 25(10):1184-1187.
9. Rose JR, Gardner MJ. Femoral head fractures. Curr Rev Musculoskelet Med, 2012, 5(3):199-205.
10. Stannard JP, Harris HW, Volgas DA, et al. Functional outcome of patiens with femoral herad fractures associated with hip dislocations. Clin Orthop Relat Res, 2000, (377):44-56.
11. Massè A, Aprato A, Alluto C, et al. Surgical hip dislocation is a reliable approach for treatment of femoral head fractures. Clin Orthop Relat Res, 2015.[Epub ahead of print].
12. Masse A, Aprato A, Rollero L, et al. Surgical dislocation technique for the treatment of acetabular fractures. Clin Orthop Relat Res, 2013, 471(12):4056-4064.
13. Gardner MJ, Suk M, Pearle A, et al. Surgical dislocation of the hip for fractures of the femoral head. J Orthop Trauma, 2005, 19(5):334-342.
14. Bastian JD, Büchler L, Meyer DC, et al. Surgical hip dislocation for osteochondral transplantation as a salvage prodecure for a femoral head impaction fracture. J Orthop Trauma, 2010, 24(12):e113-118.
15. Keel M, Eid K, Isler B, et al. The role of surgical hip dislocation in the treatment of acetabular and femoral head fractures. Eur J Traumar Emerg Surg, 2005, 30(2):138-147.
16. Kim JW, Chang JS, Bae JY, et al. Outcomes of treatment for femoral head fractures with hip dislocation-review of 20 cases. J Korean Hip Soc, 2010, 22(4):298-304.
17. Mostafa MF, El-Adl W, El-Sayed MA. Operative treatment of displaced Pipkin type Ⅰ and Ⅱ femoral head fractures. Arch Orthop Trauma Surg, 2014, 134(5):637-644.
18. Gagala J, Tarczyńska M, Gaweda K. Fixation of femoral head fractures with antologous osteochondral transfer (mosaicplasty). J Orthop Trauma, 2014, 28(9):226-230.
19. Henle P, Kloen P, Siebenrock KA. Femoral head injuries:Which treatment strategy can be recommended? Injure, 2007, 38(4):478-488.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE

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