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  • Title: Management and Outcome of Pipkin Type I and Type II Femoral Head Fractures by Ganz Surgical Dislocation of the Hip.
    Author: Sarkar R, Sarkar S, Sarkar S.
    Journal: Cureus; 2024 Aug; 16(8):e67707. PubMed ID: 39318906.
    Abstract:
    Introduction Femoral head fractures, specifically Pipkin Type I and Type II, are uncommon injuries often linked with posterior hip dislocations. Management strategies for these fractures range from conservative treatments to various surgical procedures, with open reduction and internal fixation (ORIF) being a notable option. The surgical approach for ORIF varies, and due to the rarity of the injury, a standardized management protocol is lacking. This study aims to evaluate the outcome of managing Pipkin Type I and Type II femoral head fractures using ORIF through Ganz surgical dislocation of the hip, assessing complications and analyzing the functional outcome by radiographic assessment and functional evaluation.  Methods This is a retrospective descriptive study of managing six cases of Pipkin Type I and Type II femoral head fractures with ORIF through Ganz surgical dislocation of the hip. Follow-up periods ranged from 19 to 96 months, and outcomes were evaluated using Matta's criteria for radiographic assessment and the Modified Harris Hip Score for functional evaluation. Results Known complications such as avascular necrosis (AVN) of the femoral head, heterotopic ossification (HO), post-traumatic arthritis (PTA), non-union of trochanteric osteotomy, and fracture non-union were monitored. Results showed one case of AVN, which occurred in a case of delayed open surgery following a failed primary closed reduction. All trochanteric osteotomies and femoral head fractures healed appropriately. No instances of HO or PTA were observed, even in the patient with the longest follow-up of 96 months. Discussion Controversy still exists in management and outcome of femoral head fracture among closed reduction alone, excision and ORIF using different techniques and approaches. Ganz surgical dislocation of the hip offers 360-degree visualization of acetabulum and nearly 360-degree visualization of head femur and hence an ideal exposure for working on femoral head and acetabulum. The study concludes that ORIF of femoral head fractures using the Ganz surgical dislocation approach is a viable treatment option, offering satisfactory outcomes with a low complication rate. The absence of PTA in long-term follow-ups may be attributed to meticulous removal of loose bodies and precise congruent reduction and fixation of head fragments.
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