Comparison of the modified Heuter approach and the Kocher-Langenbeck approach in the treatment of Pipkin type I and type II femoral head fractures

  • Shanxi Wang
  • Bohua Li
  • Jun Li
  • Zhengdong Zhang
  • Hai Yang
  • Lei LiuEmail author
Original Paper



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.


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.


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.


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.


Femoral head fractures Pipkin classification The Heuter approach Kocher-Langenbeck approach 



We wish to thank all of those who generously agreed to be interviewed for this research.


This work was supported by the Natural Science Foundation of China (81472061).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

264_2019_4301_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)


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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopedics, West China HospitalSichuan UniversityChengduPeople’s Republic of China

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