USING THE PIPKIN CLASSIFICATION IN DETERMINING THE TREATMENT TACTICS OF FEMORAL HEAD FRACTURES

Authors

  • Maxim Golovakha Zaporizhzhia State Medical and Pharmaceutical University. Ukraine, Ukraine
  • Weniamin Orljanski Wiener Privatklinik, Vienna. Austria, Austria
  • Tomas Braunsteiner Vienna Medical University. Austria, Austria
  • Mykhaylo Lisunov Zaporizhzhia State Medical and Pharmaceutical University. Ukraine, Ukraine
  • Volodymir Pertsov Zaporizhzhia State Medical and Pharmaceutical University. Ukraine, Ukraine

DOI:

https://doi.org/10.15674/0030-59872024127-32

Keywords:

Fracture of the femoral head, dislocation of the hip, hip joint, osteosynthesis, endoprosthetics

Abstract

Femoral head fractures are a rare injury with limited information in the literature. Recent studies have been based on small case series, indicating that the incidence of fractures in hip dislocation varies from 7 to 18 %. Fractures of the femoral head are classified according to Pipkin. Treatment is often accompanied by significant complications, and the choice of the optimal treatment method remains a matter of debate. The choice of treatment tactics affects the duration of treatment and functional outcome. The article presents the results of treatment of patients whose treatment tactics were based on the Pipkin classification. Objective. To substantiate the use of the Pipkin classification of femoral head fractures in the selection of treatment and diagnostic tactics. Methods. The study was performed by evaluating the results of treatment in 44 patients. The Pipkin classification was used to determine the treatment tactics. The results were evaluated according to the HHS scale. The results were statistically analysed by comparing the median scores for different groups using the Mann-Whitney U test. Results. The worst prognosis was for patients with Pipkin III and Pipkin IV fractures. HHS scores for patients with complicated outcomes are worse than for patients with uncomplicated outcomes. Treatment outcomes for Pipkin type III fractures are statistically significantly lower than for other types. Conclusions. Pipkin fractures are a rare and severe injury that can cause significant limb dysfunction with proper treatment. Treatment of Pipkin type I and type II includes immediate reduction of the dislocation and conservative treatment in case of satisfactory fragmentation or open reduction with metal osteosynthesis for displaced fractures; for type III and IV, open reduction and osteosynthesis are possible for young patients, and primary arthroplasty is recommended for patients over 60 years of age or with concomitant metabolic diseases.

Author Biographies

Maxim Golovakha, Zaporizhzhia State Medical and Pharmaceutical University. Ukraine

MD, Prof. in Traumatology and Orthopaedics

Weniamin Orljanski, Wiener Privatklinik, Vienna. Austria

MD, Prof. in Traumatology and Orthopaedics

Tomas Braunsteiner, Vienna Medical University. Austria

MD, Prof.

Mykhaylo Lisunov, Zaporizhzhia State Medical and Pharmaceutical University. Ukraine

MD

Volodymir Pertsov, Zaporizhzhia State Medical and Pharmaceutical University. Ukraine

MD, Prof.

References

  1. Birkett, J. (2000). Description of a Dislocation of the Head of the Femur, Complicated With its Fracture. With Remarks: Clinical Orthopaedics and Related Research, 377, 4–6. https://doi.org/10.1097/00003086-200008000-00002
  2. Bettinelli, G., Placella, G., Moharamzadeh, D., Belluati, A., & Salini, V. (2021). Articular Femoral Head Fracture Management: A Meta-analysis of Literature. Indian Journal of Orthopaedics, 55(S2), 304–313. https://doi.org/10.1007/s43465-021-00431-4
  3. Braun, B. J., Holstein, J. H., & Pohlemann, T. (2019). Pipkin Fractures. В L. Büchler & M. J. B. Keel (Ed.), Fractures of the Hip (pp. 123–137). Springer International Publishing. https://doi.org/10.1007/978-3-030-18838-2_11
  4. Enocson, A., & Wolf, O. (2022). Pipkin fractures: Epidemiology and outcome. European Journal of Trauma and Emergency Surgery, 48(5), 4113–4118. https://doi.org/10.1007/s00068-022-01951-w
  5. Pipkin, G. (1957). Treatment of Grade IV Fracture-Dislocation of the Hip: A REVIEW. JBJS, 39(5), 1027.
  6. Goulet, J. A., & Levin, P. E. (2003). Hip dislocations. In: Skeletal trauma: basic science, management, and reconstruction
  7. (рр.1657–1669). Philadelphia: Saunders.
  8. Engel, J. L., Johnsen, P., Patel, N. K., Satpathy, J., & Mounasamy, V. (2021). Pipkin type IV femoral head fractures: A case series and review of literature. European Journal of Orthopaedic Surgery & Traumatology, 31(4), 791–795. https://doi.org/10.1007/s00590-020-02838-5
  9. Zhao, B., Li, H., Yan, J., Han, L.-R., & Yang, X.-F. (2017). Pipkin type III femoral head fracture–dislocation combined with complicated acetabular fracture. Medicine, 96(50), e9214. https://doi.org/10.1097/MD.0000000000009214
  10. Wang, J., Cai, L., Xie, L., Chen, H., Guo, X., & Yu, K. (2019). 3D printing-based Ganz approach for treatment of femoral head fractures: A prospective analysis. Journal of Orthopaedic Surgery and Research, 14(1), 338. https://doi.org/10.1186/s13018-019-1383-7
  11. Mahomed, N. N., Arndt, D. C., McGrory, B. J., & Harris, W. H. (2001). The Harris hip score: Comparison of patient self-report with surgeon assessment. The Journal of Arthroplasty, 16(5), 575–580. https://doi.org/10.1054/arth.2001.23716
  12. Wang, S., Yu, X., Li, B., Ding, Q., Wang, T., Li, Q., Liu, L., & Wu, H. (2023). Pipkin type III femoral head fracture: Which treatment strategy can be recommended? Journal of Orthopaedics and Traumatology, 24(1), 28. https://doi.org/10.1186/s10195-023-00701-x
  13. Dong, D., Li, Y., Zhu, D., Yu, M., & Gu, G. (2020). Comparison of Fragment Removal Versus Internal Fixation for Treatment of Pipkin I Femoral Head Fractures: A Finite Element Analysis. International Surgery, 104(5–6), 262–268. https://doi.org/10.9738/INTSURG-D-16-00039R1

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How to Cite

Golovakha, M. ., Orljanski, W. ., Braunsteiner, T. ., Lisunov, M. ., & Pertsov, V. . (2024). USING THE PIPKIN CLASSIFICATION IN DETERMINING THE TREATMENT TACTICS OF FEMORAL HEAD FRACTURES. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (1), 27–32. https://doi.org/10.15674/0030-59872024127-32

Issue

No. 1 (2024)

Section

ORIGINAL ARTICLES

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