Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures.
The optimal surgical approach for combined femoral head and acetabular fractures (Pipkin IV) is controversial because of their rarity and lack of definitive reports. Surgical dislocation with trochanteric flip osteotomy (TFO) allows simultaneous exposure of the acetabulum and femoral head. We protected the obturator internus and inferior capsule during repair with a heavy suture at the inferior extent of the traumatic capsulotomy. We retrospectively reviewed 12 patients with Pipkin IV fractures treated using this approach during a 6-year period. The minimum followup was 24 months (mean, 47 months; range, 24-71 months). Clinical outcomes were measured using the Merle d'Aubigné-Postel and Thompson-Epstein scoring scales. Radiographically, all patients achieved healing of their acetabular fractures; 11 achieved healing of the femoral head fracture and osteonecrosis developed in one patient. The average Merle d'Aubigné-Postel score was 15.6 of 18; using the Thompson-Epstein score, 10 of the 12 patients had good or excellent outcomes, one had a fair outcome, and one had a poor outcome. Trochanteric flip osteotomy allowed for simultaneous exposure and repair of both lesions in Pipkin IV fractures. Using a uniform surgical protocol with TFO rendered clinical results comparable to previously reported outcomes in series of isolated femoral head fractures.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Solberg
Brian D
BD
Department of Orthopaedic Surgery, Cedars Sinai Medical Center, 444 South San Vicente Boulevard, Suite 603, Los Angeles, CA 90048, USA. brian.solberg@cshs.org
Moon
Charles N
CN
Franco
Dennis P
DP
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D000203:Activities of Daily Living; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D017102:Fracture Healing; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D016138:Walking
Clin Orthop Relat Res. 2000 Aug;(377):44-56
10943184
J Bone Joint Surg Br. 2001 Nov;83(8):1119-24
11764423
J Bone Joint Surg Br. 2002 Mar;84(2):300-4
11922376
J Orthop Trauma. 2003 Jul;17(6):447-50
12843732
J Bone Joint Surg Am. 1974 Sep;56(6):1103-27
4436348
J Bone Joint Surg Am. 1973 Dec;55(8):1629-32
4217797
J Bone Joint Surg Am. 1981 Oct;63(8):1292-6
7287800
Clin Orthop Relat Res. 1985 Dec;(201):9-17
4064426
J Trauma. 1986 Nov;26(11):1041-4
3783780
Hip. 1987;:181-206
3546215
J Orthop Trauma. 1991;5(4):504-5
1762016
J Orthop Trauma. 1992;6(4):437-42
1494097
J Orthop Trauma. 1996;10 Suppl 1:v-ix, 1-154
8814583
J Orthop Trauma. 1996;10(7):455-61
8892144
J Orthop Trauma. 1998 Aug;12(6):387-91
9715445
J Bone Joint Surg Am. 1951 Jul;33-A(3):746-78; passim
14850515
J Bone Joint Surg Am. 1954 Jun;36-A(3):451-75
13163078
J Bone Joint Surg Am. 1957 Oct;39-A(5):1027-42 passim
13475403
J Orthop Trauma. 2005 May-Jun;19(5):334-42
15891543
Injury. 2007 Apr;38(4):478-88
17400227