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

Abstract

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.

Figure 1:

CT-scan slice showing femoral head impaction against the acetabulum.

Figure 2:

CT-scan slice showing a Pipkin type I fracture after femoral head reduction

Figure 3:

intraoperative view of Pipkin type I fracture before reduction (A), after the achieved reduction is held by k-wires (B), after final fixation (C) and Xrays at two years follow-up (D).

Figure 4:

intraoperative arthroscopic view of the femoral head fragment before mobilization

Figure 5:

medial portal position

Figure 6:

intraoperative arthroscopic view of the femoral head fragment after reduction

Figure 7:

anteroposterior (A) and lateral (B) post-operative X-rays showing the achieved reduction and fixation of the femoral head fragment

Figure 8:

anteroposterior (A) and lateral (B) intraoperative fluoroscopic views showing the optimal direction across the fracture achieved through the medial portal.