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Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures

BACKGROUND: The purpose of the study is to evaluate clinical and radiological outcomes in those patients with femoral head fracture, treated with open reduction and internal fixation through Gibson approach and Ganz flip trochanter osteotomy. The treatment of Pipkin fractures is very challenging, es...

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Autores principales: De Mauro, Domenico, Rovere, Giuseppe, Smakaj, Amarildo, Marino, Silvia, Ciolli, Gianluca, Perna, Andrea, Battiato, Concetto, El Ezzo, Omar, Liuzza, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597876/
https://www.ncbi.nlm.nih.gov/pubmed/34789202
http://dx.doi.org/10.1186/s12891-021-04800-w
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author De Mauro, Domenico
Rovere, Giuseppe
Smakaj, Amarildo
Marino, Silvia
Ciolli, Gianluca
Perna, Andrea
Battiato, Concetto
El Ezzo, Omar
Liuzza, Francesco
author_facet De Mauro, Domenico
Rovere, Giuseppe
Smakaj, Amarildo
Marino, Silvia
Ciolli, Gianluca
Perna, Andrea
Battiato, Concetto
El Ezzo, Omar
Liuzza, Francesco
author_sort De Mauro, Domenico
collection PubMed
description BACKGROUND: The purpose of the study is to evaluate clinical and radiological outcomes in those patients with femoral head fracture, treated with open reduction and internal fixation through Gibson approach and Ganz flip trochanter osteotomy. The treatment of Pipkin fractures is very challenging, especially for small trauma centers, because of the unusual fracture patterns and high-level surgical skills required. CASE PRESENTATION: Between 2017 and 2020, nine cases of Pipkin fractures came to the Emergency Department at the Trauma Center of our Hospital in Rome. Inclusion criteria were the diagnosis of femoral head fracture, the open reduction and internal fixation as surgical choice and at least 24 months follow-up. Patients older than 65 years and those treated through total hip replacement or combined hip procedure (CHP) were excluded. Thus, five patients were included in our case series. The clinical outcome was evaluated according to Western Ontario and McMaster Universities Arthritis Index, Vail Hip score, modified Harris Hip score and Merle D’Aubignè Postel score. Radiographic assessment was scored according to Epstein-Thompson classification and heterotopic ossification was assessed through Brooker classification. The mean follow-up was 24 months (range 12-24). Average modified Harris Hip score was 92.1 points (range 75.9–100), and the average Vail score was 81.8 (range 55-95). WOMAC score was assessed in three different subscales, pain (A), stiffness (B) and physical condition (C), with the following results: 1.4 A (range 0-7), 1.2 B (range 0-6) and 6.4 C (range 0-22). Merle d’Aubignè Postel score resulted excellent for four patients and good for one patient. According to Epstein-Thompson score of the radiological outcome, four patients showed a good result and one a fair result. No mechanical or infective complications occurred in the five patients. CONCLUSIONS: Gibson’s approach and surgical hip dislocation through Ganz trochanteric flip osteotomy allow a good exposure of the femoral head and acetabulum, giving us the possibility to perform an anatomical reduction of the fracture. In our case series, satisfactory clinical and radiological short-term results were obtained without significant complications.
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spelling pubmed-85978762021-11-18 Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures De Mauro, Domenico Rovere, Giuseppe Smakaj, Amarildo Marino, Silvia Ciolli, Gianluca Perna, Andrea Battiato, Concetto El Ezzo, Omar Liuzza, Francesco BMC Musculoskelet Disord Case Study BACKGROUND: The purpose of the study is to evaluate clinical and radiological outcomes in those patients with femoral head fracture, treated with open reduction and internal fixation through Gibson approach and Ganz flip trochanter osteotomy. The treatment of Pipkin fractures is very challenging, especially for small trauma centers, because of the unusual fracture patterns and high-level surgical skills required. CASE PRESENTATION: Between 2017 and 2020, nine cases of Pipkin fractures came to the Emergency Department at the Trauma Center of our Hospital in Rome. Inclusion criteria were the diagnosis of femoral head fracture, the open reduction and internal fixation as surgical choice and at least 24 months follow-up. Patients older than 65 years and those treated through total hip replacement or combined hip procedure (CHP) were excluded. Thus, five patients were included in our case series. The clinical outcome was evaluated according to Western Ontario and McMaster Universities Arthritis Index, Vail Hip score, modified Harris Hip score and Merle D’Aubignè Postel score. Radiographic assessment was scored according to Epstein-Thompson classification and heterotopic ossification was assessed through Brooker classification. The mean follow-up was 24 months (range 12-24). Average modified Harris Hip score was 92.1 points (range 75.9–100), and the average Vail score was 81.8 (range 55-95). WOMAC score was assessed in three different subscales, pain (A), stiffness (B) and physical condition (C), with the following results: 1.4 A (range 0-7), 1.2 B (range 0-6) and 6.4 C (range 0-22). Merle d’Aubignè Postel score resulted excellent for four patients and good for one patient. According to Epstein-Thompson score of the radiological outcome, four patients showed a good result and one a fair result. No mechanical or infective complications occurred in the five patients. CONCLUSIONS: Gibson’s approach and surgical hip dislocation through Ganz trochanteric flip osteotomy allow a good exposure of the femoral head and acetabulum, giving us the possibility to perform an anatomical reduction of the fracture. In our case series, satisfactory clinical and radiological short-term results were obtained without significant complications. BioMed Central 2021-11-17 /pmc/articles/PMC8597876/ /pubmed/34789202 http://dx.doi.org/10.1186/s12891-021-04800-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Study
De Mauro, Domenico
Rovere, Giuseppe
Smakaj, Amarildo
Marino, Silvia
Ciolli, Gianluca
Perna, Andrea
Battiato, Concetto
El Ezzo, Omar
Liuzza, Francesco
Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures
title Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures
title_full Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures
title_fullStr Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures
title_full_unstemmed Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures
title_short Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures
title_sort gibson approach and surgical hip dislocation according to ganz in the treatment of femoral head fractures
topic Case Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597876/
https://www.ncbi.nlm.nih.gov/pubmed/34789202
http://dx.doi.org/10.1186/s12891-021-04800-w
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