Comparison of the efficacy of the modified S-P approach and the Ganz method for surgical hip dislocation in Pipkin I fractures: an early follow-up study.

BACKGROUND

Femoral head fractures result from high-energy trauma and may be associated with posterior dislocation of the hip joint. An appropriate surgical approach is essential for improving clinical outcomes and preventing complications. This study aims to compare the clinical efficacy of the modified Smith-Peterson (mS-P) approach and Ganz surgical dislocation (GSD) approach in the treatment of Pipkin I fractures.

METHODS

We conducted a retrospective analysis of patients diagnosed with Pipkin I fractures at Pidu District People's Hospital from June 2010 to May 2020. Of these, 11 cases were treated with the mS-P approach and 12 cases were treated with the GSD approach. All patients were followed for 12-55 months, with a mean duration of 37.7 months. Basic demographic information, perioperative-related records, postoperative complications, and outcomes at the final follow-up were compared. Functional evaluations included the Thompson-Epstein Score, the Modified Harris Hip Score (MHHS), and the Vail Hip Score (VHS).

RESULTS

Overall, 21 patients were included in the study. We found that the mS-P approach was associated with a smaller incision, shorter operative time, and reduced intraoperative blood loss compared to the GSD approach (P < 0.05). The mean MHHS was 83.5 ± 9.14 and 75 ± 9.22 in the mS-P group and GSD group, respectively, P = 0.048. The mean VHS was 83.9 ± 7.4 and 74.4 ± 11.28 in the mS-P group and GSD group, respectively, P = 0.034. Thompson-Epstein scores in the mS-P group were excellent (6 patients), good (3 patients), and fair (1 patient). In the GSD group, the scores were excellent (3 patients), good (5 patients), and fair (2 patients). Among the postoperative complications, avascular necrosis (AVN) occurred in 1 patient in each of the mS-P and GSD groups. Heterotopic ossification (HO) occurred in 5 patients in each of the mS-P and GSD groups. 2 patients in the mS-P group developed post-traumatic osteoarthritis (PTOA), compared to 5 patients in the GSD group. One patient in the GSD group developed a sciatic nerve injury (SNI).

CONCLUSIONS

This study suggests that the mS-P approach offers advantages over the GSD approach in terms of surgical efficiency and surgical trauma. However, longer-term follow-up is required to fully assess complications and functional outcomes.