Department of Traumatology and General Surgery, BG Unfallklinik Murnau, Murnau am Staffelsee, Germany.
Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
Arch Orthop Trauma Surg. 2024 Sep;144(9):4491-4497. doi: 10.1007/s00402-024-05553-6. Epub 2024 Sep 10.
A femoral head fracture (Pipkin fracture) is a rare but severe injury. The optimal treatment is controversial, and there is a lack of research focusing on treatment strategies. The study aimed to analyze the treatment strategies in comparison to the outcome in patients after traumatic hip joint dislocation (THD) with concomitant femoral head fractures.
A retrospective multicenter study at three Level I Trauma Centers was performed over a 12 year period from January 2009 to January 2021. Epidemiological data, associated injuries, and treatment were recorded. Patients were followed up for further treatment, re-operations, complications, and long-term functional outcomes using patient-reported outcome measures (PROMs), specifically the modified Harris Hip Score (mHHS) and the Tegner Activity Scale (TAS).
45 patients with a mean age of 44 ± 16.11 years were finally evaluated. The majority of 38 patients (84%) were treated surgically. The mean follow-up time was 5.75 years (range 2-12 years). 8 patients (31%) developed post-traumatic osteoarthritis and 4 patients (15%) developed osteonecrosis of the femoral head. 7 patients (27%) underwent total hip arthroplasty (THA). Fixation of the Pipkin fracture was more common in younger patients but had no statistically significant impact on PROMs. Patients with a higher BMI were significantly less likely to undergo fragment fixation (p < 0.05). TAS was significantly worse in patients who underwent THA (p < 0.05).
A femoral head fracture is a severe injury with overall limitations in activities of daily living and a high rate of post-traumatic osteoarthritis and osteonecrosis of the femoral head. Fragment fixation had no statistically significant impact on the outcome and PROMs. Treatment strategies should be guided by the fracture type, the patient's condition, and associated injuries. However, concomitant and life-threatening injuries may affect the treatment and limit the outcome.
股骨头骨折（Pipkin 骨折）是一种罕见但严重的损伤。最佳治疗方案存在争议，并且缺乏专门针对治疗策略的研究。本研究旨在分析外伤性髋关节脱位（THD）合并股骨头骨折患者的治疗策略，并比较其治疗效果。
本研究为回顾性多中心研究，共纳入了三家一级创伤中心在 2009 年 1 月至 2021 年 1 月期间收治的 45 例患者。记录了患者的流行病学数据、合并损伤以及治疗情况。通过患者报告的结局测量（PROMs），特别是改良 Harris 髋关节评分（mHHS）和 Tegner 活动量表（TAS），对患者进行了进一步的治疗、再手术、并发症和长期功能结局随访。
最终纳入的 45 例患者平均年龄为 44±16.11 岁。其中 38 例（84%）患者接受了手术治疗。平均随访时间为 5.75 年（范围 2-12 年）。8 例（31%）患者发生创伤性骨关节炎，4 例（15%）患者发生股骨头坏死。7 例（27%）患者接受了全髋关节置换术（THA）。年轻患者中更常见固定 Pipkin 骨折，但 PROMs 无统计学差异。BMI 较高的患者行骨折块固定的可能性显著降低（p<0.05）。行 THA 的患者 TAS 显著更差（p<0.05）。
股骨头骨折是一种严重损伤，患者日常生活活动受限，创伤后骨关节炎和股骨头坏死的发生率较高。骨折块固定对结局和 PROMs 无统计学影响。治疗策略应根据骨折类型、患者状况和合并损伤来确定。然而，合并危及生命的损伤可能会影响治疗并限制结局。
