Orthopaedic Department, Assiut University Hospital, Assiut, Egypt.
Orthopaedic and Traumatology Department, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga highway, Qena, 83523, Egypt.
Arch Orthop Trauma Surg. 2021 Oct;141(10):1701-1710. doi: 10.1007/s00402-020-03666-2. Epub 2020 Oct 28.
Femoral head fractures considered to be rare injuries. Surgical intervention is indicated for major fragment displacement or in the presence of instability. Surgical management can be achieved through either Anterior, posterior, and trans-trochanteric surgical approaches. Surgical hip dislocation (SHD) has been advocated by many authors to be a safe and effective alternative way of management. The aim of this study was to report on the accuracy of fracture reduction, procedure safety, and outcomes of using SHD in the management of femoral head fractures.
Between 2011 and 2017, 31 patients presented with femoral head fracture were treated through SHD. At a mean follow-up of 48 months, 27 patients were available for the study with a mean age of 33.8 years. Patient demographics, clinical evaluation according to modified Harris hip score and modified Merle d'Aubigne and Postel score, radiographic fracture reduction according to Matta's criteria, and any complications were reported.
Excellent and good clinical outcomes were reported in 25 (92.6%) and 24 (89%) patients according to the modified Harris hip and modified Merle d'Aubigne and Postel scores, respectively. Anatomic fracture reduction was achieved in 21 (77.8%) patients. Two (7.4%) patients developed AVN, one (3.6%) patient developed hip OA (grade 3 according to Tönnis classification), and five (18.5%) patients developed asymptomatic Brooker stage I heterotopic ossification. No infection or trochanteric flip osteotomy fragment non-union was reported.
SHD offers a safe and efficient approach for femoral head fractures management with acceptable clinical outcomes as well as complication rates. Giving the advantage of fully exposing the femoral head and the acetabulum which enables the surgeon to anatomically reduce the fracture and treat any associated injuries, SHD is recommended besides other approaches for the management of femoral head fractures.
股骨颈骨折被认为是罕见的损伤。对于大的骨折块移位或存在不稳定的患者，需要进行手术干预。手术入路可选择前路、后路和转子间入路。许多作者主张采用髋关节后脱位（SHD）作为一种安全有效的治疗方法。本研究旨在报告使用 SHD 治疗股骨颈骨折的骨折复位准确性、手术安全性和结果。
2011 年至 2017 年，31 例股骨颈骨折患者采用 SHD 治疗。在平均 48 个月的随访中，27 例患者纳入研究，平均年龄为 33.8 岁。报告了患者的人口统计学资料、根据改良 Harris 髋关节评分和改良 Merle d'Aubigne 和 Postel 评分的临床评估、根据 Matta 标准的影像学骨折复位情况以及任何并发症。
根据改良 Harris 髋关节评分和改良 Merle d'Aubigne 和 Postel 评分，分别有 25 例（92.6%）和 24 例（89%）患者获得了优秀和良好的临床结果。21 例（77.8%）患者获得了解剖复位。2 例（7.4%）患者发生股骨头坏死，1 例（3.6%）患者发生髋关节骨关节炎（Tönnis 分级 3 级），5 例（18.5%）患者发生无症状 Brooker Ⅰ级异位骨化。无感染或转子间翻转截骨块不愈合发生。
SHD 为股骨颈骨折的治疗提供了一种安全有效的方法，具有可接受的临床结果和并发症发生率。SHD 可充分显露股骨头和髋臼，使外科医生能够对骨折进行解剖复位，并治疗任何相关损伤，除其他入路外，推荐用于股骨颈骨折的治疗。
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