Skip to main content


Log in

Trochanteric osteotomy for acetabular fracture fixation: a case series and literature review

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript



This study examined osteotomy union and heterotopic ossification (HO) after performing digastric trochanteric osteotomies during open reduction and internal fixation (ORIF) of acetabular and combined femoral head fractures. Femoral head osteonecrosis and trochanteric screw removal were secondarily assessed.


Twenty-six patients treated at a Level I trauma center, from years 2003 to 2019, who received a digastric trochanteric osteotomy during acetabular and combined femoral head fracture ORIF through a posterior surgical approach were retrospectively identified. Osteotomies were fixed with two 3.5 mm cortical lag screws. Rates of osteotomy union, HO, femoral head osteonecrosis, and trochanteric screw removal were determined.


All osteotomies went onto union without displacement or failure of fixation. Only three (12%) patients developed severe HO (modified-Brooker class III–IV). There were no instances of femoral head osteonecrosis and only one (7%) patient required trochanteric screw removal.


The digastric trochanteric osteotomy heals reliably with low rates of severe HO, femoral head osteonecrosis, and screw removal for soft-tissue irritation. A review of the literature is presented and found comparable findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Siebenrock KA, Gautier E, Ziran BH, Ganz R (1998) Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher–Langenbeck approach. J Orthop Trauma 12:387–391

    Article  CAS  Google Scholar 

  2. Solberg BD, Moon CN, Franco DP (2009) Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures. Clin Orthop Relat Res 467:929–933

    Article  Google Scholar 

  3. Siebenrock KA, Gautier E, Woo AK, Ganz R (2002) Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum. J Orthop Trauma 16:543–552

    Article  Google Scholar 

  4. Ebraheim NA, Patil V, Liu J, Haman SP (2007) Sliding trochanteric osteotomy in acetabular fractures: a review of 30 cases. Injury 38:1177–1182

    Article  Google Scholar 

  5. Hadjicostas PT, Thielemann FW (2008) The use of trochanteric slide osteotomy in the treatment of displaced acetabular fractures. Injury 39:907–913

    Article  Google Scholar 

  6. Naranje S, Shamshery P, Yadav CS, Gupta V, Nag HL (2010) Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures. Arch Orthop Trauma Surg 130:93–101

    Article  Google Scholar 

  7. Tannast M, Krüger A, Mack PW, Powell JN, Hosalkar HS, Siebenrock KA (2010) Surgical dislocation of the hip for the fixation of acetabular fractures. J Bone Joint Surg Br 92:842–852

    Article  CAS  Google Scholar 

  8. Masse A, Aprato A, Rollero L, Bersano A, Ganz R (2013) Surgical dislocation technique for the treatment of acetabular fractures. Clin Orthop Relat Res 471:4056–4064

    Article  Google Scholar 

  9. Dubina AG, Wickramaratne N, O'Toole RV, Manson TT (2017) Assessment of trochanteric osteotomy fragment union after acetabular fracture surgery. Injury 48:384–387

    Article  Google Scholar 

  10. Gupta S, Singh J, Virk JS (2017) The role of trochanteric flip osteotomy in fixation of certain acetabular fractures. Chin J Traumatol 20:161–165

    Article  Google Scholar 

  11. Trikha V, Das S, Madegowda A, Agrawal P (2018) Midterm results of trochanteric flip osteotomy technique for management of fractures around the hip. Hip Int 28:148–155

    Article  Google Scholar 

  12. Steppacher SD, Huemmer C, Schwab JM, Tannast M, Siebenrock KA (2014) Surgical hip dislocation for treatment of femoroacetabular impingement: factors predicting 5-year survivorship. Clin Orthop Relat Res 472:337–348

    Article  Google Scholar 

  13. Beaulé PE, Singh A, Poitras S, Parker G (2015) Surgical dislocation of the hip for the treatment of pre-arthritic hip disease. J Arthroplasty 30:1502–1505

    Article  Google Scholar 

  14. Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 151:81–106

    Google Scholar 

  15. Ficat P, Arlet J (1980) Necrosis of the femoral head. Ischemia and necrosis of Bone. Williams & Wilkins, Baltimore, pp 53–74

    Google Scholar 

  16. Moed BR, Smith ST (1996) Three-view radiographic assessment of heterotopic ossification after acetabular fracture surgery. J Orthop Trauma 10:93–98

    Article  CAS  Google Scholar 

  17. Bosse MJ, Poka A, Reinert CM, Ellwanger F, Slawson R, McDevitt ER (1988) Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation. J Bone Joint Surg Am 70:1231–1237

    Article  CAS  Google Scholar 

  18. Gautier E, Ganz K, Krügel 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

    Article  CAS  Google Scholar 

  19. Zhang YZ, Cao XY, Li XC, Chen J, Zhao YY, Tian Z et al (2018) Accuracy of MRI diagnosis of early osteonecrosis of the femoral head: a meta-analysis and systematic review. J Orthop Surg Res 13:167

    Article  Google Scholar 

Download references


No funding was provided for this study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael J. Chen.

Ethics declarations

Conflict of interest

M.J.G. receives personal fees from Pacira Pharmaceuticals, Biocomposites, BoneSupport AB, Conventus, Globus Medical, StabilizOrtho, Synthes, and from KCI outside of the submitted work. None of the remaining authors have anything to disclose.

Ethical approval

This article contained only de-identified human participant information and was approved by an institutional review board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, M.J., Wadhwa, H., Tigchelaar, S.S. et al. Trochanteric osteotomy for acetabular fracture fixation: a case series and literature review. Eur J Orthop Surg Traumatol 31, 161–165 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: