Management of femoral head fractures through surgical hip dislocation (SHD): a demanding but safe technique
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TRAUMA SURGERY
Management of femoral head fractures through surgical hip dislocation (SHD): a demanding but safe technique Ahmed A. Khalifa1,2 · Omar Refai1 · Osama Farouk1 · Mohammad Kamal Abdelnasser1 Received: 5 May 2020 / Accepted: 15 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Femoral head fractures considered to be rare injuries. Surgical intervention is indicated for major fragment displacement or in the presence of instability. Surgical management can be achieved through either Anterior, posterior, and trans-trochanteric surgical approaches. Surgical hip dislocation (SHD) has been advocated by many authors to be a safe and effective alternative way of management. The aim of this study was to report on the accuracy of fracture reduction, procedure safety, and outcomes of using SHD in the management of femoral head fractures. Patients and methods Between 2011 and 2017, 31 patients presented with femoral head fracture were treated through SHD. At a mean follow-up of 48 months, 27 patients were available for the study with a mean age of 33.8 years. Patient demographics, clinical evaluation according to modified Harris hip score and modified Merle d’Aubigne and Postel score, radiographic fracture reduction according to Matta’s criteria, and any complications were reported. Results Excellent and good clinical outcomes were reported in 25 (92.6%) and 24 (89%) patients according to the modified Harris hip and modified Merle d’Aubigne and Postel scores, respectively. Anatomic fracture reduction was achieved in 21 (77.8%) patients. Two (7.4%) patients developed AVN, one (3.6%) patient developed hip OA (grade 3 according to Tönnis classification), and five (18.5%) patients developed asymptomatic Brooker stage I heterotopic ossification. No infection or trochanteric flip osteotomy fragment non-union was reported. Conclusions SHD offers a safe and efficient approach for femoral head fractures management with acceptable clinical outcomes as well as complication rates. Giving the advantage of fully exposing the femoral head and the acetabulum which enables the surgeon to anatomically reduce the fracture and treat any associated injuries, SHD is recommended besides other approaches for the management of femoral head fractures. Keywords Femoral head · Surgical hip dislocation · Pipkin fracture · Ganz
Introduction * Ahmed A. Khalifa [email protected] http://www.svu.edu.eg Omar Refai [email protected] Osama Farouk [email protected] Mohammad Kamal Abdelnasser [email protected] 1
Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
Orthopaedic and Traumatology Department, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena‑Safaga highway, Qena 83523, Egypt
2
Being an intraarticular fracture and resulting from a highenergy trauma, femoral head fracture, although considered rare, however, it represents distinctive challenges for the trauma surgeon in terms of protocol of management
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