Surgical hip dislocation vs arthroscopy for fixation of subfoveal femoral head fractures: A new technique for Pipkin type 1 fractures

Main Article Content

Alessandro Aprato
Marco Buzzone
Paolo Di Benedetto
Alessandro Massè

Keywords

femoral head fracture, hip arthroscopy, safe surgical dislocation, Pipkin fracture, medial hip arthroscopic portal

Abstract

Background. Reduction and fixation of Pipkin type I femoral head fractures may be performed either via surgical dislocation either via hip arthroscopy but to our knowledge no studies compared those techniques. Aim of our study is to compare (1) Fracture reduction quality, (2) modified Harris hip score at a minimum of 2 years, and (3) Frequency of complications in a case series of patients with femoral head fractures treated with those approaches.


Methods Five cases of arthroscopic fixation of femoral head fracture (AG) have been compared with our historical cohort (8 patients, SDG). Patient demographic, injury, and surgical variables as well as complications were recorded and retrospectively evaluated. Radiographic outcome was scored according to Matta’s criteria on postoperative radiographs and clinical outcomes were evaluated with the modified Harris hip score.


Results Fracture reduction was anatomic in five hips and imperfect in two in the SDG while four hip were classified as anatomic and one imperfect in the AG. The mean clinical scores were significantly different between the two groups (p=0.03): 88 points in SDG (SD 7) and 94 points in AG (SD 5). In the SDG, one patient developed symptomatic femoral head AVN and one had heterotopic ossification. In the AG, no complication (heterotopic ossification and AVN) but one grade I sign of arthritis were noted.


Conclusions Arthroscopic reduction and fixation of Pipkin type I fracture shows radiographic results comparable to surgical dislocation but better clinical results and lower rate of comorbidity.

Abstract 494 | PDF Downloads 202

References

1. Thompson VP, Epstein HC. Traumatic dislocation of the hip: a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg Am. 1951; 33:746–778.
2. Clegg TE, Roberts CS, Greene JW, Prather BA. Hip dislocations—epidemiology, treatment, and outcomes. Injury 2010. April;41(4):329-334.
3. Beebe MJ, Bauer JM, Mir HR. Treatment of hip dislocations and associated injuries: current state of care. Orthop Clin North Am. 2016. July;47(3):527-549
4. Dawson-Amoah K, Raszewski J, Duplantier N, Waddell BS. Dislocation of the Hip: A Review of Types, Causes, and Treatment. Ochsner J. 2018;18(3):242-252.
5. Pipkin G. Treatment of Grade IV fracture-dislocation of the hip. A review. J Bone Joint Surg Am. 1957;39:1027-1197
6. Oransky M, Martinelli N, Sanzarello I, Papapietro N .Fractures of the femoral head: a long-term follow-up study. Musculoskelet Surg 2012;96:95–99.
7. Aprato A, Nardi M, Arduini M, et al Italian Consensus Conference on Guidelines for preoperative treatment in acetabular fractures Acta Biomedica, in press
8. Gillespie P, Aprato A, Bircher M. Hip dislocation and femoral head fractures. In: Bentley G, ed. European Surgical Orthopaedics and Traumatology: the Efort Textbook. Berlin, Heidelberg, Germany: Springer; 2014:2179-2202.
9. Alonso JE, Volgas DA, Giordano V, Stannard JP. A review of the treatment of hip dislocations associated with acetabular fractures. Clin Orthop Relat Res. 2000;377:32-43.
10. Masse A, Aprato A, Rollero L, Bersano A, Ganz R. Surgical dislocation technique for the treatment of acetabular fractures. Clin Orthop Relat Res. 2013 Dec;471(12):4056-64.
11. Aprato A, Bertolo F, Bistolfi A, Sabatini L, Massè A. The Use of Hip Arthroscopy in Trauma of the Hip. In: Büchler L., Keel M. (eds) Fractures of the Hip. Fracture Management Joint by Joint. Springer 2019; 189-196
12. Aprato A, Reboli M, Olivero M, Massè A. Hip Arthroscopy in Trauma In Aprato A (Ed) What’s new in hip arthroscopy, Novapublishers. ISBN: 978-1-53619-321-3
13. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78:1632–1645
14. Tönnis D. Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res. 1976;119:39-47.
15. Brooker A, Bowerman J, Robinson R, Riley LH. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1955;55:1629–1632
16. Massè A, Aprato A, Alluto C, Favuto M, Ganz R. Surgical hip dislocation is a reliable approach for treatment of femoral head fractures. Clin Orthop Relat Res. 2015 Dec;473(12):3744-51.
17. Aprato A, Giachino M, Masse A. Arthroscopic approach and anatomy of the hip. Muscles Ligaments Tendons J. 2016 Dec 21;6(3):309-316.
18. Polesello GC, Queiroz MC, de Figueiredo MJPSS, Braga SR, Ricioli W Jr, Akkari M. Medial hip arthroscopy portals: a novel approach for hip pathologies. Is it feasible? Hip Int. 2017 May 12;27(3):e3-e5.
19. Kang C, Hwang DS, Hwang JM, Park EJ. Usefulness of the Medial Portal during Hip Arthroscopy. Clin Orthop Surg. 2015 Sep;7(3):392-5.
20. Bistolfi A, Guidotti C, Aprato A, et al. Rehabilitation protocol following hip arthroscopy. A 2015 to 2020 systematic review. Am J Phys Med Rehabil. 2020 Dec 29;
21. Jayasekera N, Aprato A, Villar RN. Are crutches required after hip arthroscopy? A case-control study. Hip Int. 2013 May-Jun;23(3):269-73.
22. Gardner MJ, Suk M, Pearle A, Buly RL, Helfet DL, Lorich DG. Surgical dislocation of the hip for fractures of the femoral head. J Orthop Trauma. 2005;19:334–342.
23. Henle P, Kloen P, Siebenrock KA. Femoral head injuries: which treatment strategy can be recommended? Injury Int J Care Injured. 2007;38:478-488
24. 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;134:637-644
25. Solberg BD, Moon CN, Franco DP. Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures. Clin Orthop Relat Res. 2009;467:929-933
26. Lansford T, Munns SW. Arthroscopic treatment of Pipkin type I femoral head fractures: a report of 2 cases. J Orthop Trauma. 2012 Jul;26(7):e94-6.
27. Yamamoto Y, Ide T, Ono T, et al. Usefulness of arthroscopic surgery in hip trauma cases. Arthroscopy 2003;19:269-273
28. Matsuda DK (2009) A rare fracture, an even rarer treatment: the arthroscopic reduction and internal fixation of and isolated femoral head fracture. Arthroscopy 25:408–412
29. Park MS, Yoon SJ, Choi SM. Hip Arthroscopic Management for Femoral Head Fractures and Posterior Acetabular Wall Fractures (Pipkin Type IV). Arthrosc Tech. 2013 Jun 22;2(3):e221-5.
30. Park MS, Her IS, Cho HM, Chung YY. Internal fixation of femoral head fractures (Pipkin I) using hip arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2014 Apr;22(4):898-901.
31. Kekatpure A, Ahn T, Lee SJ, Jeong MY, Chang JS, Yoon PW. Arthroscopic Reduction and Internal Fixation for Pipkin Type I Femoral Head Fracture: Technical Note. Arthrosc Tech. 2016 Sep 5;5(5):e997-e1000.
32. Aprato A, Jayasekera N, Villar RN. Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy? Am J Sports Med. 2012 Nov;40(11):2557-60.
33. Lichte P, Sellei RM, Kobbe P, Dombroski DG, Gänsslen A, Pape HC. Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study. Patient Saf Surg. 2013 Mar 19