Management of femoral head fracture by Ganz surgical dislocation of the hip

Abstract

Introduction: Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture.

Patients and methods: In this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta's criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d'Aubigne and Postel score at final follow-up.

Results: No patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta's criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d'Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results.

Conclusion: Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate.

Keywords: Femoral head fracture; Femoral head osteonecrosis; Ganz technique; Hip dislocation; Pipkin classification; Trochanteric flip osteotomy.

Fig. 1

Intraoperative photo showing head of femur with type 1 Pipkin fracture

Fig. 2

Intraoperative photo showing fixation of head of femur with screws

Fig. 3

Intraoperative photo showing positive drilling test (arrow)

Fig. 4

Preoperative radiograph of a female 35-year-old patient with left hip dislocation and fracture of the femoral head (Pipkin type 1 fracture)

Fig. 5

A Preoperative CT scan showing head femur fracture (axial view). B Preoperative CT scan showing head femur fracture (coronal view)

Fig. 6

Immediate postoperative plain radiograph showing femoral head fixation

Fig. 7

Follow-up radiograph at 1 month postoperatively

Fig. 8

Follow-up radiograph 2 years postoperatively

Fig. 9

A, B Preoperative radiograph of a male 28-year-old patient with right hip dislocation and fracture of the femoral head (Pipkin type 2 fracture)

Fig. 10

Follow-up radiograph at 12 months showing femoral head osteonecrosis