Clinical results of femoral head fracture-dislocation treated according to the Pipkin classification.

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Abstract

11. Orthopedics. 2011 May 18;34(5):350. doi: 10.3928/01477447-20110317-09. Operative versus nonoperative management of Pipkin type-II fractures associated with posterior hip dislocation. Chen ZW(1), Zhai WL, Ding ZQ, Lian KJ, Kang LQ, Guo LX, Liu H, Lin B. Author information: (1)Department of Orthopedics, 175th Hospital of PLA, Traumatic Orthopedics Center of PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian Province, PR China. Little has been written on randomized, controlled studies of operative versus nonoperative management of Pipkin type-II fractures associated with posterior dislocation of the hip. It is difficult to validate the optimal management of these fractures. The goals of this study were to (1) evaluate the results of conservative and surgical treatment for Pipkin type-II fractures associated with posterior dislocation of the hip and supply the optimal management for these fractures and (2) identify whether the Smith-Petersen approach is a safe and reliable surgical approach for Pipkin type-II fractures.Twenty-four patients were randomly divided into 2 groups: the conservative group (n=12) was treated by closed reduction, and the surgical group (n=12) was treated by primary open reduction internal fixation (ORIF) by bioabsorbable screws via a Smith-Petersen approach. Minimum follow-up was 24 months. Functional outcome was measured using the Thompson and Epstein score and the d'Aubigné-Postel score. Heterotopic ossification was classified based on the Brooker classification. The outcome of the conservative group was worse than that of the surgical group (P=.037). Two patients in the conservative group needed joint replacement for avascular necrosis of the femoral head. Heterotopic ossification was found in 6 patients (1 patient in the conservative group and 5 in the surgical group).Primary ORIF by bioabsorbable screws via a Smith-Petersen approach is an effective treatment for Pipkin type-II fractures associated with posterior dislocation. Copyright 2011, SLACK Incorporated. DOI: 10.3928/01477447-20110317-09