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Sarkar R, Sarkar S, Sarkar S. Management and Outcome of Pipkin Type I and Type II Femoral Head Fractures by Ganz Surgical Dislocation of the Hip. Cureus 2024; 16:e67707. [PMID: 39318906 PMCID: PMC11420702 DOI: 10.7759/cureus.67707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction Femoral head fractures, specifically Pipkin Type I and Type II, are uncommon injuries often linked with posterior hip dislocations. Management strategies for these fractures range from conservative treatments to various surgical procedures, with open reduction and internal fixation (ORIF) being a notable option. The surgical approach for ORIF varies, and due to the rarity of the injury, a standardized management protocol is lacking. This study aims to evaluate the outcome of managing Pipkin Type I and Type II femoral head fractures using ORIF through Ganz surgical dislocation of the hip, assessing complications and analyzing the functional outcome by radiographic assessment and functional evaluation. Methods This is a retrospective descriptive study of managing six cases of Pipkin Type I and Type II femoral head fractures with ORIF through Ganz surgical dislocation of the hip. Follow-up periods ranged from 19 to 96 months, and outcomes were evaluated using Matta's criteria for radiographic assessment and the Modified Harris Hip Score for functional evaluation. Results Known complications such as avascular necrosis (AVN) of the femoral head, heterotopic ossification (HO), post-traumatic arthritis (PTA), non-union of trochanteric osteotomy, and fracture non-union were monitored. Results showed one case of AVN, which occurred in a case of delayed open surgery following a failed primary closed reduction. All trochanteric osteotomies and femoral head fractures healed appropriately. No instances of HO or PTA were observed, even in the patient with the longest follow-up of 96 months. Discussion Controversy still exists in management and outcome of femoral head fracture among closed reduction alone, excision and ORIF using different techniques and approaches. Ganz surgical dislocation of the hip offers 360-degree visualization of acetabulum and nearly 360-degree visualization of head femur and hence an ideal exposure for working on femoral head and acetabulum. The study concludes that ORIF of femoral head fractures using the Ganz surgical dislocation approach is a viable treatment option, offering satisfactory outcomes with a low complication rate. The absence of PTA in long-term follow-ups may be attributed to meticulous removal of loose bodies and precise congruent reduction and fixation of head fragments.
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Affiliation(s)
- Rajib Sarkar
- Orthopaedics, ICARE Institute of Medical Sciences and Research, Haldia, IND
| | - Samriddhi Sarkar
- Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Pondicherry, IND
| | - Sayantika Sarkar
- Emergency Medical Services, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
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Kloub M, Látal P, Giannoudis P. Techniques and results of reconstruction of femoral head fractures: An Update. Injury 2024; 55:111473. [PMID: 38538488 DOI: 10.1016/j.injury.2024.111473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 05/24/2024]
Abstract
A narrative review of the literature was conducted to examine the data on femoral head fractures, with a particular focus on their management, complications and clinical outcomes. A PRISMA strategy was used. Medline and Scopus library databases were queried using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. The 50 eligible articles that met the predefined inclusion criteria reported on 1403 femoral head fractures. A detailed analysis of the surgical approaches used was performed in 38 articles with 856 fractures. Most fractures were treated surgically (90,8 %) with preferred anatomical reconstruction in 76,7 % of all operatively treated cases. Posterior approaches were the most common (52.5 %). This was evenly split between surgical hip dislocation and the classic Kocher-Langenbeck approach. 70.5 % of surgically treated cases achieved excellent or good result according to Thompson-Epstein criteria. Highest rate of excellent results showed minimal invasive osteosynthesis and surgical hip dislocation. Major late complications were avascular necrosis (10.8 %), post-traumatic arthritis (16.2 %) and heterotopic ossification (20.8 %). Secondary THA was necessary in 6.9 %. Highest rate of major complications was joined with anterior approach (77 %), lowest rate from frequently used approaches surgical hip dislocation (37.8 %). Conservative treatment recedes into the background. The Ganz flip osteotomy with surgical hip dislocation allows safe treatment of all types of fractures and should be considered the first choice, offering the lowest rate of complications and one of the best functional outcomes. Reconstruction of Pipkin Type III fractures should be reserved for very young patients due to high rate of major complications.
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Affiliation(s)
- Martin Kloub
- Department of Traumatology Hospital České Budějovice, Czech Republic.
| | - Pavel Látal
- Department of Traumatology Hospital České Budějovice, Czech Republic
| | - Peter Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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Sifi N, Bouguenna R. Relevance of the Watson-Jones anterolateral approach in the management of Pipkin type II fracture-dislocation: a case report and literature review. JOURNAL OF TRAUMA AND INJURY 2024; 37:161-165. [PMID: 39380619 PMCID: PMC11309222 DOI: 10.20408/jti.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/29/2024] [Indexed: 10/10/2024] Open
Abstract
Femoral head fractures with associated hip dislocations substantially impact the functional prognosis of the hip joint and present a surgical challenge. The surgeon must select a safe approach that enables osteosynthesis of the fracture while also preserving the vascularization of the femoral head. The optimal surgical approach for these injuries remains a topic of debate. A 44-year-old woman was involved in a road traffic accident, which resulted in a posterior iliac dislocation of the hip associated with a Pipkin type II fracture of the femoral head. Given the size of the detached fragment and the risk of incarceration preventing reduction, we opted against attempting external orthopedic reduction maneuvers. Instead, we chose to perform open reduction and internal fixation using the Watson-Jones anterolateral approach. This involved navigating between the retracted tensor fascia lata muscle, positioned medially, and the gluteus medius and minimus muscles, situated laterally. During radiological and clinical follow-up visits extending to postoperative month 15, the patient showed no signs of avascular necrosis of the femoral head, progression toward coxarthrosis, or heterotopic ossification. The Watson-Jones anterolateral approach is a straightforward intermuscular and internervous surgical procedure. This method provides excellent exposure of the femoral head, preserves its primary vascularization, allows for anterior dislocation, and facilitates the anatomical reduction and fixation of the fracture.
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Affiliation(s)
- Nazim Sifi
- Orthopaedic and Trauma Surgery Unit, EPH Beni Abbes, Beni Abbes, Algeria
| | - Ryad Bouguenna
- Orthopaedic and Trauma Surgery Unit, EPH Beni Abbes, Beni Abbes, Algeria
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Moreau PE, Upex P, Mahieu A, Ziran N, Riouallon G. Minimally invasive femoral head fracture fixation using three-dimensional navigation: a technical note. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1707-1710. [PMID: 38236397 DOI: 10.1007/s00590-023-03812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/15/2023] [Indexed: 01/19/2024]
Abstract
Femoral head fractures are rare traumatic injuries that are usually associated with hip dislocations. Open reduction and internal fixation are performed when indicated, but can be associated with a higher risk of avascular necrosis. We report the case of a 24-year-old patient with a Pipkin type II fracture dislocation of the femoral head fixed via a minimally invasive three-dimensional navigated internal fixation technique. This technique minimizes deep soft tissue dissection to the hip capsule and associated vascularity and allows for accurate implant positioning.Level of evidence: Therapeutic case report Level IV.
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Affiliation(s)
- Pierre-Emmanuel Moreau
- Orthopedic and Traumatology Department, Paris Saint-Joseph Hospital, 185, Rue Raymond Losserand, 75014, Paris, France.
| | - Peter Upex
- Orthopedic and Traumatology Department, Paris Saint-Joseph Hospital, 185, Rue Raymond Losserand, 75014, Paris, France
| | - Alizée Mahieu
- Orthopedic and Traumatology Department, Paris Saint-Joseph Hospital, 185, Rue Raymond Losserand, 75014, Paris, France
| | - Navid Ziran
- Orthopedic and Traumatology Department, Paris Saint-Joseph Hospital, 185, Rue Raymond Losserand, 75014, Paris, France
- St. Joseph's Hospital and Medical Center, 500W. Thomas Road Suite 850, Phoenix, AZ, 85013, USA
| | - Guillaume Riouallon
- Orthopedic and Traumatology Department, Paris Saint-Joseph Hospital, 185, Rue Raymond Losserand, 75014, Paris, France
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Kolin DA. CORR Insights®: Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility? Clin Orthop Relat Res 2024; 482:87-88. [PMID: 37606953 PMCID: PMC10723880 DOI: 10.1097/corr.0000000000002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/27/2023] [Indexed: 08/23/2023]
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Khalifa AA, Hassan TG, Haridy MA. The evolution of surgical hip dislocation utilization and indications over the past two decades: a scoping review. INTERNATIONAL ORTHOPAEDICS 2023; 47:3053-3062. [PMID: 37103574 PMCID: PMC10673723 DOI: 10.1007/s00264-023-05814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To assess the evolution of surgical hip dislocation (SHD) utilization over the past 20 years, concentrating mainly on the patients' population (adults vs. paediatric), the hip conditions treated using this approach, and reporting on complications of this procedure. METHODS This scoping review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A PubMed database search was performed using specific search terms for articles related to SHD published between January 2001 and November 2022. RESULTS Initial search revealed 321 articles, of which 160 published in 66 journals from 28 countries were eligible for final analysis. The number of publications increased by 10.2 folds comparing the period from 2001 to 2005 with 2018 to 2022. USA and Switzerland contributed to more than 50% of the publications. Case series studies represented the majority of publications (65.6%). Articles including adult patients represented 73.1% of the publications while 10% were on paediatric patients; however, there was 14 folds increase in publications on paediatric patients comparing the first with the last five years. Managing non-traumatic conditions was reported in 77.5% of the articles, while traumatic conditions in 21.9%. Femoroacetabular impingement (FAI) was the most treated non-traumatic condition reported in 53 (33.1%) articles. In contrast, femoral head fractures (FHF) were the most treated traumatic condition, which was reported in 13 articles. CONCLUSION The publications on SHD and its usage for managing traumatic and non-traumatic hip conditions showed an increasing trend over the past two decades from worldwide countries. Its use in adult patients is well established, and its utilization in treating paediatric hip conditions is becoming more popular.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopaedic Department, Qena faculty of medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga highway, Qena, Egypt.
| | - Tohamy G Hassan
- Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Kim CH, Ma DS, Cho HC, Yoon YC. Comparison of Postoperative Complications Between Trochanter Flip Osteotomy and Kocher-Langenbeck Approaches for the Treatment of Femoral Head Fractures: A Systematic Review and Meta-analysis. Indian J Orthop 2023; 57:577-585. [PMID: 37006726 PMCID: PMC10050544 DOI: 10.1007/s43465-023-00846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/12/2023] [Indexed: 04/04/2023]
Abstract
Purpose The study aims to identify the optimal approach for femoral head fracture (FHF) by comparing the postoperative complications and outcome score of the Kocher-Langenbeck posterior approach (KLP) and trochanteric flip osteotomy (TFO) through a systematic review and meta-analysis. Methods MEDLINE, Embase and the Cochrane Library were systematically searched for studies published up to 22 January 2023, which compared TFO to the KLP for FHF treatment. The main outcomes of this meta-analysis were the rate of postoperative complications including osteonecrosis of the femoral head (ONFH), heterotopic ossification (HO), and total hip replacement (THR) conversion rate and Thompson-Epstein (T-E) score at the final follow-up. Results We included four studies with 57 cases of FHFs; 27 and 30 patients underwent TFO and the KLP, respectively. Following the pooled analysis, HO incidence was significantly higher in TFO than in the KLP (OR = 4.03; 95% CI 1.10-14.81; P = 0.04; I 2 = 0%), but there were no differences in other variables, including the incidence of ONFH (OR = 0.41; 95% CI 0.07-2.35; P = 0.32; I 2 = 0%), THR conversion rate (OR = 0.82; 95% CI 0.16-4.29; P = 0.81; I 2 = 0%), and number of inferior results in the T-E score (OR = 0.49; 95% CI 0.14-1.73; P = 0.27; I 2 = 0%). Conclusions Amongst the posterior approaches for FHFs, the KLP and TFO did not present significant clinical and radiological differences; hence, the approach can be selected depending on the surgeon's experience and preference.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Sung Ma
- Department of Thoracic & Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Dongnam-gu, Cheonan Chungnam, Republic of Korea
| | - Hyung-Chul Cho
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, (21565) 21 Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon, Republic of Korea
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An open reduction and internal fixation of a Pipkin type 1 fracture: A case report. Ann Med Surg (Lond) 2022; 84:104850. [PMID: 36582860 PMCID: PMC9793203 DOI: 10.1016/j.amsu.2022.104850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/23/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
Abstract
•A rare case of a Pipkin fracture type 1.•Emphasizing the importance of using clinical radiology precisely.•Using ORIF procedure urgently has significant better outcomes.•Protecting patients from femoral head necrosis and improving their mobility.
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Influence of associated femoral head fractures on surgical outcomes following osteosynthesis in posterior wall acetabular fractures. BMC Musculoskelet Disord 2022; 23:830. [PMID: 36050675 PMCID: PMC9434972 DOI: 10.1186/s12891-022-05777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background To date, no study has compared the surgical outcomes between posterior wall acetabular fractures with and without associated femoral head fractures. Therefore, we evaluated whether an associated femoral head fracture increases the incidence of fracture sequelae, including post-traumatic osteoarthritis (PTOA) and osteonecrosis of the femoral head (ONFH), following osteosynthesis for posterior wall acetabular fractures. Methods This retrospective clinical study enrolled 183 patients who underwent osteosynthesis for posterior wall acetabular fractures between 2009 and 2019 at a level-1 trauma center. The incidence of PTOA, ONFH, and conversion to total hip arthroplasty (THA) was reviewed. Results The incidence of PTOA, ONFH, and conversion to THA following osteosynthesis were 20.2%, 15.9%, and 17.5%, respectively. The average time for conversion to THA was 18.76 ± 20.15 months (range, 1–82). The results for the comparison of patients with associated femoral head fractures and isolated posterior wall acetabular fractures were insignificant (PTOA: 27.3% vs. 15.7%, p = 0.13; ONFH: 18.2% vs. 14.3%, p = 0.58; conversion to THA: 20.4% vs. 15.7%, p = 0.52). Upon evaluating other variables, only marginal impaction negatively affected ONFH incidence (odds ratio: 2.90). Conclusions Our methods failed to demonstrate a significant difference in the rate of PTOA, ONFH, or conversion to THA in posterior wall acetabular fractures with and without an associated femoral head fracture. Beyond femoral head fractures, the marginal impaction of the acetabulum could have led to early sequelae. Level of evidence Level III
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Ferreira N, Britz E, Gould A, Harrison WD. The management of segmental femur fractures: the radiographic 'cover-up' test to guide decision making. Injury 2022; 53:2865-2871. [PMID: 35690487 DOI: 10.1016/j.injury.2022.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/04/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Segmental femur fractures often pose management challenges regarding the optimal fixation choice and sequence of surgical events. METHODS Retrospective review of clinical records and radiographic data of adult patients with segmental femur fractures treated by a conceptual radiographic cover-up test to determine the ideal fixation method between January 2019 and December 2020. RESULTS Forty patients with 84 individual fractures underwent fracture fixation. The most consistent fracture combinations were intertrochanter-diaphysis (AO31A-AO32) fractures (25%, n = 10) and femur neck-diaphysis (AO31B-AO32) fractures (20%, n = 8). Compared to evidence-based fracture management, the gold standard treatment was used for the fixation of 78 fractures (93%). One patient required revision for fixation failure of a diaphyseal fracture, and two fractures, both open diaphysis injuries, developed fracture-related infections. CONCLUSION Anatomical alignment and high union rates are possible for segmental femur fractures treated by evidence-based fracture fixation principles. A conceptual radiographic cover-up test assists in matching the best possible implant for each fracture.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa.
| | - Elsabe Britz
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Alan Gould
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - William D Harrison
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
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Management of femoral head fracture by Ganz surgical dislocation of the hip. J Orthop Traumatol 2022; 23:24. [PMID: 35538323 PMCID: PMC9091069 DOI: 10.1186/s10195-022-00643-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/16/2022] [Indexed: 11/10/2022] Open
Abstract
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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Khalifa AA, Ahmed EM, Farouk OA. Surgical Approaches for Managing Femoral Head Fractures (FHFs); What and How to Choose from the Different Options? Orthop Res Rev 2022; 14:133-145. [PMID: 35497088 PMCID: PMC9045708 DOI: 10.2147/orr.s353582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/02/2022] [Indexed: 11/23/2022] Open
Abstract
Femoral head fractures (FHFs) are considered a relatively uncommon injury; however, they carry a challenge to the trauma surgeon. Choosing the appropriate management option, either conservatively or surgically, if the latter was chosen, should it be open reduction and internal fixation or simple excision of the fragment, or acute total hip arthroplasty. Furthermore, selecting the best surgical approach through which surgical management could be performed depends on the fracture classification, the familiarity of the surgeon, and the presence of associated injuries. All approaches to the hip, including hip arthroscopy, had been proposed for the management of FHFs; however, the difference among approaches is related to the complexity of the approach, the need for special training or equipment, the effect of the approach on the functional outcomes as well as the rate of postoperative complications. This review discussed the possible surgical approaches used to manage FHFs, advantages, and disadvantages for each, and offered a guideline for selecting the most appropriate surgical approach.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| | - Esraa M Ahmed
- Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Osama A Farouk
- Orthopedic and Traumatology department, Assiut University Hospital, Assiut, Egypt
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Khalifa AA, Haridy MA, Fergany A. Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis. World J Orthop 2021; 12:604-619. [PMID: 34485106 PMCID: PMC8384609 DOI: 10.5312/wjo.v12.i8.604] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/20/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
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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Affiliation(s)
- Ahmed A Khalifa
- Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qena 83523, Qina, Egypt
| | - Mohamed A Haridy
- Department of Orthopaedic, Ibri Regional Hospital, Ibri 511, Oman
| | - Ali Fergany
- Department of Orthopaedic, Assiut University Hospital, Assiut 71515, Egypt
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Clinical application of hip arthroscopy-assisted reduction and internal fixation in the treatment of femoral head fracture. Asian J Surg 2021; 44:915-917. [PMID: 33965322 DOI: 10.1016/j.asjsur.2021.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
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Häfner SJ. Don't sugar coat the COVID (only the vasculature). Biomed J 2020; 43:393-398. [PMID: 33115641 PMCID: PMC7547304 DOI: 10.1016/j.bj.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022] Open
Abstract
This issue of the Biomedical Journal acquaints us with the compelling hypothesis that the vascular glycocalyx lies at the intersection of severe COVID-19 risk factors and damages, and the ways used by artificial intelligence to predict interactions between SARS-CoV-2 and human proteins. Furthermore, we explore the antiviral potential of valinomycin and the long list of COVID-19-related clinical trials, and learn how (not) to fix a broken femoral head. Last but not least, we get to enjoy the tale of the cellular oxygen-sensing system as well as the role of the host complement system during Leptospira infection, and learn that SARS-CoV-2 can sometimes come with a pathogenic plus one.
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Affiliation(s)
- Sophia Julia Häfner
- University of Copenhagen, BRIC Biotech Research & Innovation Centre, Anders Lund Group, Copenhagen, Denmark.
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