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. 2025 Apr 8;26(1):343.
doi: 10.1186/s12891-025-08583-2.

Clinical analysis of Ganz approach in the treatment of Pipkin type IV fracture: a retrospective review

Zhiwen Wang #  1 , Guy Romeo Kenmegne #  2   3 , Jingjun Zeng  1 , Ming Chen  4
Affiliations

Clinical analysis of Ganz approach in the treatment of Pipkin type IV fracture: a retrospective review

Zhiwen Wang et al. BMC Musculoskelet Disord. .

Abstract

Purpose: This study aimed to evaluate the early clinical outcomes of the Ganz approach in treating Pipkin IV fractures.

Methods: From January 2016 to January 2021, 22 patients with Pipkin IV fracture were treated in our department with Ganz approach. The operation time, intraoperative blood loss, fracture healing time, the incidence of postoperative complications such as heterotopic ossification of hip joint and avascular necrosis of femoral head were recorded. Radiological assessment of fracture reduction was achieved using Matta's evaluation criteria. The functional recovery of the hip joint was assessed using the Harris Hip Score at one year and before the current study, as well as the modified Merle d'Aubigné and Postel score during the final evaluation.

Results: 21 patients were available for follow up. The average intraoperative blood loss was 145.5 ± 39.3 ml and the average operation time was 150.4 ± 40.6 min. The average follow-up time was 39.2 ± 11.2 months. X-ray confirmed bony healing of the femoral head, acetabular fractures, and greater trochanter osteotomy, with an average healing time of 7.22 ± 3 months. The difference between the Harris hip score of hip joint at one year and at the last follow-up was not statistically significant (p = 0.06). At final follow up with the modified Merle D'Aubigne Postel score, nine had excellent functional outcome; ten presented very good to good result while two patients had average (one) to poor (one) result. Two (9.5%) patient developed osteonecrosis (avascular necrosis) of the femoral head.

Conclusion: The Ganz approach effectively preserves the blood supply to the femoral head, moreover, it also fully expose the operative fields such as hip joint and femoral head, achieving satisfactory clinical outcomes, making it a valuable option for clinical application.

Keywords: Acetabular fracture; Femoral head fracture; Greater trochanter osteotomy; Internal fixation; Pipkin IV.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Helsinki declaration of 1975. This study was approved by the Institutional Review Board and the Ethics Committee of The first affiliated hospital of Nanchang University (Date-number: 2023 − 220). All patients provided informed consent prior to their participation in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Intraoperative images: (a) shows the intraoperative fracture exposure after flexion-external rotation of the femur, dislocation of the hip joint and full exposure of the femoral head; (b) demonstrates intraoperative temporary fixation with pointed reduction forceps; (c) Intraoperative drilling test showing bleeding of the fractured femoral head; (d) intraoperative fluoroscopic image demonstrating good fracture reduction
Fig. 2
Fig. 2
A 28-years-old female, who sustained a road traffic accident and presented with right Pipkin IV femoral head fracture: (a) preoperative X-ray image of the; (b) 3D CT showed fracture of the femoral head with fracture of the posterior wall of the acetabulum; (c) 2D CT scan coronal section showing posterior dislocation of the fractured femoral head; (d), (e) and (f) reveal the postoperative radiographic images at respectively one day, three months and one year. (d) and (h) demonstrate a good hip function at one year follow-up
See this image and copyright information in PMC

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