Treatment of PIPKIN type II fracture of femoral head by direct anterior approach

LI Hao; WU Zhenyu; WANG Dalin

doi:10.3969/j.issn.1674-666X.2016.05.002

Abstract：Objective To investigate the feasibility and clinical effect of minimally invasive direct anterior approach (DAA) for treatment of PIPKIN type II fracture of femoral head. Methods A retrospective analysis of clinical data of 10 patients with PIPKIN type II fracture of femoral head (traffic accident in 8 patients and high falling accident in 2 patients) was performed, who were treated by DAA from September 2012 to June 2014 in Affiliated Hospital of Beihua University. Length of incision, operation time and intraoperative estimate blood loss were recorded, Harris hip score before and after operation as well as postoperative Thompson-Epstein clinical result were evaluated, and postoperative complications were observed. Results The average length of incision was (10.3 ± 1.3) cm, average operation time was (67 ± 11) min, average intraoperative estimate blood loss was (71 ± 15) mL. All patients were followed up for 12-16 months (average, 13.4 months). Harris hip scores 3, 6 and 12 months after the surgery were all better than preoperative ones, the differences showed statistically significance (P <0.05). According to Thompson-Epstein clinical evaluation standard, the assessment at 12 months after the operation was excellent in 6 patients, good in 2, fair in 1 and poor in 1, with the excellent and good rate was 8/10. Femoral head necrosis occurred in 1 case, heterotopic ossification in 2 and short-term numbness in innervation area in 2 cases. Conclusion DAA is a good choice of approach for treatment of PIPKIN type II fracture of femoral head, because it has the advantages of less surgical injury, short operation time, less blood loss and good recovery of hip function, with less interference to soft tissue and easy exposure and operating.