Abstract
Purpose
To evaluate and compare the effectiveness of the modified Heuter approach and the Kocher-Langenbeck approach in the treatment of Pipkin type I and II femoral head fractures.
Methods
The study cohort consisted of 39 patients with Pipkin type I or type II femoral head fractures who were treated by open reduction and internal fixation through the modified Heuter approach (the Heuter group) or the Kocher-Langenbeck approach (the K-L group) between June 2013 and January 2016. Standard radiographs and computed tomography (CT) scans were obtained before surgery and during the follow-up. The two approaches were compared in reference to operative time, amount of blood loss, the occurrence of complications, and final functional outcome. The Brooker classification was used to document heterotopic ossification and the Thompson-Epstein scores were used for final evaluation.
Results
The mean operative time and estimated blood loss in the Heuter group were lower than those in the K-L group (P < 0.001 for both measures). The incisions healed primarily in all patients after surgery, no infection or deep venous thromboses were detected in either group, post-operative imaging data showed that dislocation and fractures were reduced, and the fractures finally achieved bony union. There were no significant differences in the incidence of complications or final functional outcomes between the two groups.
Conclusions
Compared with the Kocher-Langenbeck approach, the modified Heuter approach can effectively reduce the blood loss and operative time without increasing the risk of complications; this approach is simple, straightforward, and atraumatic and may be a viable option for open reduction and internal fixation of Pipkin type I and type II femoral head fractures.
Similar content being viewed by others
References
Birkett J (1869) Description of a dislocation of the head of the femur, complicated with its fracture: with remarks. Med Chir Trans 52:133–138
Pipkin G (1957) Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am 39-A:1027–1042
Droll KP, Broekhuyse H, O'Brien P (2007) Fracture of the femoral head. J Am Acad Orthop Surg 15:716–727
Epstein HC (1974) Posterior fracture-dislocations of the hip: long-term follow-up. J Bone Joint Surg Am 56:1103–1127
Dreinhofer KE, Schwarzkopf SR, Haas NP, Tscherne H (1996) Femur head dislocation fractures. Long-term outcome of conservative and surgical therapy. UNFALLCHIRURG 99:400–409
Tripathy SK, Sen RK, Goyal T (2011) Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial. Int Orthop 35:1907
Schonweiss T, Wagner S, Mayr E, Ruter A (1999) Late results after fracture of the femoral head. UNFALLCHIRURG 102:776–783
Brumback RJ, Kenzora JE, Levitt LE, Burgess AR, Poka A (1987) Fractures of the femoral head. Hip:181–206
Lang-Stevenson A, Getty CJ (1987) The Pipkin fracture-dislocation of the hip. Injury 18:264–269
Marchetti ME, Steinberg GG, Coumas JM (1996) Intermediate-term experience of Pipkin fracture-dislocations of the hip. J Orthop Trauma 10:455–461
Roeder LJ, DeLee JC (1980) Femoral head fractures associated with posterior hip dislocation. Clin Orthop Relat Res:121–130
Henle P, Kloen P, Siebenrock KA (2007) Femoral head injuries: which treatment strategy can be recommended? Injury 38:478–488
Mostafa MF, El-Adl W, El-Sayed MA (2014) Operative treatment of displaced Pipkin type I and II femoral head fractures. Arch Orthop Trauma Surg 134:637–644
Nast-Kolb D, Ruchholtz S, Schweiberer L (1997) Treatment of Pipkin fractures. Orthopade 26:360–367
Epstein HC, Wiss DA, Cozen L (1985) Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop Relat Res:9–17
Hougaard K, Thomsen PB (1988) Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both. J Bone Joint Surg Am 70:233–239
Davis JB (1950) Simultaneous femoral head fracture and traumatic hip dislocation. Am J Surg 80:893–895
Funsten RV, Kinser P, Frankel CJ (1938) Dashboard dislocation of the hip: a report of twenty cases of traumatic dislocation. Jbjs 20:124–132
Swiontkowski MF, Thorpe M, Seiler JG, Hansen ST (1992) Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures. J Orthop Trauma 6:437–442
Kloen P, Siebenrock KA, Raaymakers ELFB, Marti RK, Ganz R (2002) Femoral head fractures revisited. Eur J Trauma 28:221–233
Leslie MP, Wolinsky JP (2010) Treatment of femoral head fractures. Tech Orthop 25:155–159
Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U (2001) Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br Vol 83:1119–1124
Paillard P (2007) Hip replacement by a minimal anterior approach. Int Orthop 31(Suppl 1):S13–S15
JUDET J, JUDET R (1950) The use of an artificial femoral head for arthroplasty of the hip joint. J Bone Joint Surg Br 32-B:166–173
JUDET R, JUDET J (1952) Technique and results with the acrylic femoral head prosthesis. J Bone Joint Surg Br 34-B:173–180
Light TR, Keggi KJ (1980) Anterior approach to hip arthroplasty. Clin Orthop Relat Res:255–260
Kennon R, Keggi J, Zatorski LE, Keggi KJ (2004) Anterior approach for total hip arthroplasty: beyond the minimally invasive technique. J Bone Joint Surg Am 86-A(Suppl 2):91–97
Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124
Rudert M, Horas K, Hoberg M, Steinert A, Holzapfel DE, Hübner S, Holzapfel BM (2016) The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint. BMC Musculoskel DIS 17:57
Fahey JJ (1949) Surgical approaches to bones and joints. Surg Clin North Am 29:65–76
O’Brien RM (1955) The technic for insertion of femoral head prosthesis by the straight anterior or Hueter approach. Clin Orthop 6:22
Kurtz WJ, Vrabec GA (2009) Fixation of femoral head fractures using the modified Heuter direct anterior approach. J Orthop Trauma 23:675–680
Guo JJ, Tang N, Yang HL, Qin L, Leung KS (2010) Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures: a systematic review. Int Orthop 34:319–322
Trueta J, Harrison MH (1953) The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br 35-B:442–461
Gautier E, Ganz K, Krugel N, Gill T, Ganz R (2000) Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 82:679–683
Stockenhuber N, Schweighofer F, Seibert FJ (1994) Diagnosis, therapy and prognosis of Pipkin fractures (femur head dislocation fractures). Chirurg 65:976
Stannard JP, Harris HW, Volgas DA, Alonso JE (2000) Functional outcome of patients with femoral head fractures associated with hip dislocations. Clin Orthop Relat Res (377):44–56
Thompson VP, Epstein HC (1951) Traumatic dislocation of the hip: a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg Am 33-A:746–778
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification[J]. J Bone Joint Surg Am 55(8):1629–1632
Acknowledgments
We wish to thank all of those who generously agreed to be interviewed for this research.
Funding
This work was supported by the Natural Science Foundation of China (81472061).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 17 kb)
Rights and permissions
About this article
Cite this article
Wang, S., Li, B., Li, J. et al. Comparison of the modified Heuter approach and the Kocher-Langenbeck approach in the treatment of Pipkin type I and type II femoral head fractures. International Orthopaedics (SICOT) 43, 2613–2620 (2019). https://doi.org/10.1007/s00264-019-04301-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-019-04301-5