title: Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Cedars Sinai Medical Center, 444 South San Vicente Boulevard, Suite 603, Los Angeles, CA 90048, USA. brian.solberg@cshs.org
authors.forename: Brian D
authors.initials: BD
authors.lastname: Solberg
authors.forename: Charles N
authors.initials: CN
authors.lastname: Moon
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Franco
mesh_terms: 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
references.citation: Clin Orthop Relat Res. 2000 Aug;(377):44-56
references.pmid: 10943184
references.citation: J Bone Joint Surg Br. 2001 Nov;83(8):1119-24
references.pmid: 11764423
references.citation: J Bone Joint Surg Br. 2002 Mar;84(2):300-4
references.pmid: 11922376
references.citation: J Orthop Trauma. 2003 Jul;17(6):447-50
references.pmid: 12843732
references.citation: J Bone Joint Surg Am. 1974 Sep;56(6):1103-27
references.pmid: 4436348
references.citation: J Bone Joint Surg Am. 1973 Dec;55(8):1629-32
references.pmid: 4217797
references.citation: J Bone Joint Surg Am. 1981 Oct;63(8):1292-6
references.pmid: 7287800
references.citation: Clin Orthop Relat Res. 1985 Dec;(201):9-17
references.pmid: 4064426
references.citation: J Trauma. 1986 Nov;26(11):1041-4
references.pmid: 3783780
references.citation: Hip. 1987;:181-206
references.pmid: 3546215
references.citation: J Orthop Trauma. 1991;5(4):504-5
references.pmid: 1762016
references.citation: J Orthop Trauma. 1992;6(4):437-42
references.pmid: 1494097
references.citation: J Orthop Trauma. 1996;10 Suppl 1:v-ix, 1-154
references.pmid: 8814583
references.citation: J Orthop Trauma. 1996;10(7):455-61
references.pmid: 8892144
references.citation: J Orthop Trauma. 1998 Aug;12(6):387-91
references.pmid: 9715445
references.citation: J Bone Joint Surg Am. 1951 Jul;33-A(3):746-78; passim
references.pmid: 14850515
references.citation: J Bone Joint Surg Am. 1954 Jun;36-A(3):451-75
references.pmid: 13163078
references.citation: J Bone Joint Surg Am. 1957 Oct;39-A(5):1027-42 passim
references.pmid: 13475403
references.citation: J Orthop Trauma. 2005 May-Jun;19(5):334-42
references.pmid: 15891543
references.citation: Injury. 2007 Apr;38(4):478-88
references.pmid: 17400227