title: [Treatment of Pipkin type I fracture of femoral head associated with posterior dislocation of the hip].
abstract: OBJECTIVE
  To evaluate and compare the outcomes of simple closed reduction, selective fragment excision after closed reduction, and emergency fragment excision and reduction in the treatment of Pipkin type I fracture of femoral head associated with posterior dislocation of the hip.
  
  
  METHODS
  Between January 2002 and January 2008, 24 patients with Pipkin type I fracture of the femoral head associated with posterior dislocation of the hip were treated with simple closed reduction (closed reduction group, n=8), with selective fragment excision after closed reduction (selective operation group, n=8), and with emergency fragment excision and reduction (emergency operation group, n=8). In the closed reduction group, there were 6 males and 2 females with an average age of 37.6 years (range, 19-56 years); injuries were caused by traffic accident in 6 cases, by falling from height in 1 case, and by crushing in 1 case with a mean disease duration of 3.1 hours (range, 1.0-7.5 hours); and the interval from injury to reduction was (4.00 +/- 2.14) hours. In the selective operation group, there were 7 males and 1 female with an average age of 37.3 years (range, 21-59 years); injuries were caused by traffic accident in 7 cases and by falling from height in 1 case with a mean disease duration of 3.2 hours (range, 1.0-6.0 hours); and the interval from injury to reduction was (3.90 +/- 1.47) hours. In the emergency operation group, there were 5 males and 3 females with an average age of 35.5 years (range, 20-58 years); injuries were caused by traffic accident in 5 cases, by falling from height in 1 case, and by crushing in 2 cases with a mean disease duration of 3.3 hours (range, 1.5-6.5 hours); and the interval from injury to open reduction was (5.10 +/- 2.04) hours. There was no significant difference in the age, gender, disease duration, and interval from injury to reduction among 3 groups (P > 0.05).
  
  
  RESULTS
  All wounds in selective operation group and emergency operation group healed primarily. All the patients were followed up 24 to 58 months (mean, 38.7 months). According to Thompson-Epstein system, the excellent and good rates were 50.0% (4/8) in the closed reduction group, 87.5% (7/8) in the selective operation group, and 87.5% (7/8) in the emergency operation group at 24 months after operation, showing significant difference among 3 groups (chi2 = 9.803, P = 0.020). Heterotopic ossification was found in 1 case (12.5%) of the closed reduction group, in 4 cases (50.0%) of the selective operation group, and in 4 cases (50.0%) of the emergency operation group, and avascular necrosis of femoral head was found in 2 cases (25.0%) of the closed reduction group; there was no significant difference in complications among 3 groups (P > 0.05).
  
  
  CONCLUSIONS
  The treatment of Smith-Petersen approach and fragment excision by selective operation or emergency operation has similar outcome, which are better than the treatment of simple closed reduction.
authors.affiliation: Department of Orthopaedics, the 175th Hospital of Chinese PLA, Traumatic Orthopaedic Center of Chinese PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou Fujian, PR China.
authors.forename: Zhiwen
authors.initials: Z
authors.lastname: Chen
authors.forename: Bin
authors.initials: B
authors.lastname: Lin
authors.forename: Zhenqi
authors.initials: Z
authors.lastname: Ding
authors.forename: Kejian
authors.initials: K
authors.lastname: Lian
authors.forename: Liangqi
authors.initials: L
authors.lastname: Kang
authors.forename: Linxin
authors.initials: L
authors.lastname: Guo
authors.forename: Wenliang
authors.initials: W
authors.lastname: Zhai
mesh_terms: D000328:Adult; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000601:surgery*; D006617:Hip Dislocation / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D055815:Young Adult