title: Emergent surgical reduction and fixation for Pipkin type I femoral fractures.
abstract: The purpose of this study was to assess the effect of timing of large fragment fixation in patients with Pipkin type-I fractures. Patients with Pipkin type-I fractures from the authors' trauma center were prospectively observed between July 2007 and July 2010. Fragments that constituted more than one-fourth of the femoral head were included. Thirty-six patients were equally randomized to undergo emergent surgical reduction and fixation or secondary operative fixation after emergent closed reduction. No significant differences existed between the 2 groups with regard to the baseline characteristics, operating time, and blood loss (P>.05). However, the emergent surgical reduction and fixation group had a shorter hospital stay (P<.05). The results after more than 2-year follow-up showed that the complication and avascular necrosis rates were higher in the secondary operative fixation after emergent closed reduction group compared with the emergent surgical reduction and fixation group (P<.05). It was difficult to achieve an anatomically reduced femoral head when the fragments constituted more than one-fourth of the femoral head. Patients who underwent secondary operative fixation after emergent closed reduction had a high avascular necrosis rate and a relatively poor outcome. Emergent surgical reduction and fixation should be performed shortly after injury to enhance the treatment outcome.
authors.affiliation: Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People’s Liberation Army, Zhangzhou, China.
authors.forename: Dasheng
authors.initials: D
authors.lastname: Lin
authors.forename: Kejian
authors.initials: K
authors.lastname: Lian
authors.forename: Zhiwen
authors.initials: Z
authors.lastname: Chen
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Jianming
authors.initials: J
authors.lastname: Hao
authors.forename: Huantang
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000328:Adult; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors; D055815:Young Adult