Surgical hip dislocation approach for treatment of Pipkin type IV fractures

Objective To investigate clinical efficacy of surgical hip dislocation approach(Ganz approach)used in the treatment of Pipkin type Ⅳ fracture(combined fracture of femoral head and acetabulum). Methods We retrospectively reviewed 5 patients who had been treated for Pipkin type Ⅳ fracture through surgical hip dislocation approach between June 2010 and December 2014. They were 3 men and 2 women, with an average age of 38. 2 years(from 21 to 57 years). According to Pipkin classification, the fractures of femoral head were type I(2 cases)and type Ⅱ(3 ones). According to Letournel-Judet classification, the acetabular fractures were one posterior wall fracture, 2 posterior column and posterior wall fractures, and 2 posterior wall and hemitransverse fractures. All patients received reduction and supracondylar bone traction within 8 hours after injury, and surgery 5 to 12 days after injury. The Ganz approach was made. The trochanteric fragment was displaced anteriorly. After a Z-shaped capsulotomy, the visualized hip joint was dislocated. The acetabulum was fixated after the femoral head was reduced and fixated. Postoperative traction continued for 4 weeks. The outcomes were evaluated in terms of avascular necrosis of the femoral head, heterotopic ossification and Thompson-Epstein scores. Results All patients obtained fine radiographic reduction and union of the fractures of femoral head and acetabulum. The patients were followed up for an average of 18 months(from 6 to 36 months). Necrosis of the femoral head of stage Ib- Ⅱb(by International Bone Circulation Society Scale)without obvious symptoms occurred in one case. Necrosis of the femoral head of stage Ⅲb 1 occurred in another who was treated by total hip replacement. Heterotopic ossification occurred in one case. No infection, implant failure, or nonunion of fracture of femoral head or acetabulum happened. By the Thompson-Epstein score, 3 patients were excellent, one good and one fair. Conclusion The surgical hip dislocation approach(Ganz approach)is fine for the treatment of Pipkin type IV fracture, because it can not only protect the remaining vessels of the femoral head but also fully reveal the acetabulum and the femoral head. Key words: Femoral head; Acetabulum; Fractures, bone; Surgical approach