Analysis of effectiveness of greater trochanteric osteotomy approach and K-L posterior approach in patients with type <b>Ⅳ</b> Pipkin fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Hanwen , GE Jianhua , ZHANG Xihai , YE Junwu , SHEN Shi , ZHUO Naiqiang , YANG Yunkang , WANG Guan , LI Yang ,  LU Xiaobo

Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

LU Xiaobo, Email: luxiaobo1963@126.com

Keywords：

Pipkin fracture; greater trochanteric osteotomy approach; K-L posterior approach

DOI：

10.7507/1002-1892.202003059

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Objective To investigate the effectiveness of two surgical approaches in the treatment of type Ⅳ Pipkin fracture.Methods The clinical data of 15 patients with type Ⅳ Pipkin fracture treated surgically between July 2013 and June 2018 were retrospectively analyzed. According to different surgical approaches, they were divided into group A (8 cases, using K-L posterior approach) and group B (7 cases, using greater trochanter osteotomy approach). There was no significant difference in gender, age, cause of injury, and interval from injury to operation between the two groups (P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, fracture healing time, and complications of the two groups were recorded. Hip joint function recovery was evaluated according to Thompson-Epstein functional evaluation system.Results All the 15 patients were followed up 1-5 years, with an average of 2.5 years. There was no significant difference in operation time between the two groups (t=14.681, P=0.100); the incision length, intraoperative blood loss, and fracture healing time in group A were all greater than those in group B, and the hospital stay was shorter than that in group B, showing significant differences (P<0.05). In group A, 1 patient presented hip pain, clasthenia, and limited mobility after operation, 1 patient presented ossifying myositis, 1 patient presented osteonecrosis of the femoral head, 1 patient presented fat liquefaction of incision, and 1 patient presented sciatica, with a complication incidence of 62.5%. Postoperative hip pain occurred in 1 patient and ossifying myositis in 2 patients in group B, with a complication incidence of 42.9%. There was no significant difference in the incidence of complications between the two groups (χ²=−0.735, P=0.462). At last follow-up, according to Thompson-Epstein functional evaluation system, the results in group A were excellent in 3 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 62.5%; in group B, the results were excellent in 4 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 85.7%. There was no significant difference in good and fair rate between the two groups (χ²=−0.990, P=0.322).Conclusion K-L posterior approach is more convenient in the fracture treatment during operation, but it has greater trauma, greater vascular damage, and more blood loss. The greater trochanter osteotomy approach can better protect the blood supply of femoral head, shorten the operation time, reduce intraoperative blood loss, and reduce postoperative complications. It is an ideal way in the surgical treatment of type Ⅳ Pipkin fracture.

Citation： ZHANG Hanwen, GE Jianhua, ZHANG Xihai, YE Junwu, SHEN Shi, ZHUO Naiqiang, YANG Yunkang, WANG Guan, LI Yang, LU Xiaobo. Analysis of effectiveness of greater trochanteric osteotomy approach and K-L posterior approach in patients with type Ⅳ Pipkin fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1258-1262. doi: 10.7507/1002-1892.202003059 Copy

1.	Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg (Br), 1953, 35-B(3): 442-461.
2.	Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg (Br), 1965, 47: 560-573.
3.	王贤, 尹东, 金先跃, 等. 髋关节外科脱位入路治疗 PipkinⅣ 型股骨头骨折. 中华骨与关节外科杂志, 2019, 12(6): 464-467.
4.	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-A(3): 746-778.
5.	Roeder LF, DeLee JC. Femoral head fractures associated with posterior hip dislocation. Clin Orthop Relat Res, 1980, (147): 121-130.
6.	左伟, 梁宪军. 可吸收螺钉治疗青壮年股骨头骨折. 中国修复重建外科杂志, 2008, 22(4): 130-132.
7.	翁蔚宗, 曹烈虎, 周启荣, 等. 大转子截骨入路可吸收螺钉治疗股骨头骨折疗效分析. 中国矫形外科杂志, 2017, 25(6): 481-486.
8.	刘世学, 杨晓东, 夏广, 等. 髋关节外科脱位入路治疗 PipkinⅣ 型骨折. 中华创伤骨科杂志, 2016, 18(8): 715-719.
9.	Hougaard K, Thomsen PB. Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both. J Bone Joint Surg (Am), 1988, 70(2): 233-239.
10.	Pape H, Stalp M, Dahlweid M, et al. Optimal duration of primary surgery with regards to a “Borderline”-situation in polytrauma patients. Arbeitsgemeinschaft “Polytrauma” der deutschen gesellschaft für unfallchirurgie. Unfallchirurg, 1999, 102(11): 861-869.
11.	蒋煜青, 黄健, 郭伟康, 等. 改良 Smith-Peterson 和 Hardinge 入路治疗 PipkinⅠ 型及 Ⅱ 型股骨头骨折的病例对照研究. 中国骨伤, 2017, 30(7): 616-621.
12.	Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12): 1245-1251.
13.	李沁, 黄富国, 项舟, 等. 经改良 Hueter 入路治疗 PipkinⅠ 型及 Ⅱ 型骨折的疗效观察. 中国修复重建外科杂志, 2018, 32(3): 334-337.
14.	Gardner MJ, Suk M, Pearle A, et al. Surgical dislocation of the hip for fractures of the femoral head. J Orthop Trauma, May-Jun 2005, 19(5): 334-342.
15.	Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop Relat Res, 1985, (201): 9-17.
16.	Nötzli HP, Siebenrock KA, Hempfing A, et al. Perfusion of the femoral head during surgical dislocation of the hip. monitoring by laser doppler flowmetry. J Bone Joint Surg (Br), 2002, 84(2): 300-304.
17.	Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg (Br), 2001, 83(8): 1119-1124.
18.	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.
19.	Henriques RS, Ramalho D, Soares Do Brito J, et al. Management of pipkin fractures using a safe surgical hip dislocation. Case Reports in Orthopedics, 2019, 2019: 3526018.
20.	陈志伟, 戴祝, 廖瑛, 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.
21.	Siebenrock KA, Gautier E, Woo AK, et al. Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum. J Orthop Trauma, 2002, 16(8): 543-552.

1. Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg (Br), 1953, 35-B(3): 442-461.
2. Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg (Br), 1965, 47: 560-573.
3. 王贤, 尹东, 金先跃, 等. 髋关节外科脱位入路治疗 PipkinⅣ 型股骨头骨折. 中华骨与关节外科杂志, 2019, 12(6): 464-467.
4. 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-A(3): 746-778.
5. Roeder LF, DeLee JC. Femoral head fractures associated with posterior hip dislocation. Clin Orthop Relat Res, 1980, (147): 121-130.
6. 左伟, 梁宪军. 可吸收螺钉治疗青壮年股骨头骨折. 中国修复重建外科杂志, 2008, 22(4): 130-132.
7. 翁蔚宗, 曹烈虎, 周启荣, 等. 大转子截骨入路可吸收螺钉治疗股骨头骨折疗效分析. 中国矫形外科杂志, 2017, 25(6): 481-486.
8. 刘世学, 杨晓东, 夏广, 等. 髋关节外科脱位入路治疗 PipkinⅣ 型骨折. 中华创伤骨科杂志, 2016, 18(8): 715-719.
9. Hougaard K, Thomsen PB. Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both. J Bone Joint Surg (Am), 1988, 70(2): 233-239.
10. Pape H, Stalp M, Dahlweid M, et al. Optimal duration of primary surgery with regards to a “Borderline”-situation in polytrauma patients. Arbeitsgemeinschaft “Polytrauma” der deutschen gesellschaft für unfallchirurgie. Unfallchirurg, 1999, 102(11): 861-869.
11. 蒋煜青, 黄健, 郭伟康, 等. 改良 Smith-Peterson 和 Hardinge 入路治疗 PipkinⅠ 型及 Ⅱ 型股骨头骨折的病例对照研究. 中国骨伤, 2017, 30(7): 616-621.
12. Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12): 1245-1251.
13. 李沁, 黄富国, 项舟, 等. 经改良 Hueter 入路治疗 PipkinⅠ 型及 Ⅱ 型骨折的疗效观察. 中国修复重建外科杂志, 2018, 32(3): 334-337.
14. Gardner MJ, Suk M, Pearle A, et al. Surgical dislocation of the hip for fractures of the femoral head. J Orthop Trauma, May-Jun 2005, 19(5): 334-342.
15. Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop Relat Res, 1985, (201): 9-17.
16. Nötzli HP, Siebenrock KA, Hempfing A, et al. Perfusion of the femoral head during surgical dislocation of the hip. monitoring by laser doppler flowmetry. J Bone Joint Surg (Br), 2002, 84(2): 300-304.
17. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg (Br), 2001, 83(8): 1119-1124.
18. 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.
19. Henriques RS, Ramalho D, Soares Do Brito J, et al. Management of pipkin fractures using a safe surgical hip dislocation. Case Reports in Orthopedics, 2019, 2019: 3526018.
20. 陈志伟, 戴祝, 廖瑛, 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.
21. Siebenrock KA, Gautier E, Woo AK, et al. Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum. J Orthop Trauma, 2002, 16(8): 543-552.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of effectiveness of greater trochanteric osteotomy approach and K-L posterior approach in patients with type Ⅳ Pipkin fracture

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