Open reduction and Herbert screw fixation of Pipkin type IV femoral head fracture in an adolescent:A case report

BACKGROUND Femoral head fracture is extremely rare in children.This may be the youngest patient with femoral head fracture ever reported in the literature.There are few pediatric studies that focus on cases treated with open reduction via the modified Hardinge approach.CASE SUMMARY A 14-year-old female adolescent suffered a serious traffic accident when she was sitting on the back seat of a motorcycle.A pelvic radiograph and computed tomography revealed a proximal femoral fracture and slight acetabular rim fracture.This was diagnosed as a Pipkin type IV femoral head fracture.An open reduction and Herbert screw fixation was performed via a modified Hardinge approach.After 1-year follow-up,the patient could walk without aid and participate in physical activities.The X-ray results showed that the fractures healed well with no evidence of complications.CONCLUSION Open reduction and Herbert screw fixation is an available therapy to treat Pipkin type IV femoral head fractures in children.

Treatment of a femoral neck fracture combined with ipsilateral femoral head and intertrochanteric fractures: A case report

BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.

Subchondral fatigue fracture of the femoral head in young military recruits:Potential risk factors

BACKGROUND Subchondral fatigue fracture of the femoral head(SFFFH)mainly occurs in young military recruits and might be confused with osteonecrosis of the femoral head.However,less research focuses on the risk factor for SFFFH.AIM To evaluate the intrinsic risk factors for SFFFH in young military recruits.METHODS X-ray and magnetic resonance imaging data were used for analysis.Acetabular anteversion of the superior acetabulum,acetabular anteversion of the center of the acetabulum(AVcen),anterior acetabular sector angle(AASA),posterior acetabular sector angle,superior acetabular sector angle,neck-shaft angle(NSA),inferior iliac angle(IIA),and ischiopubic angle were calculated.Then,logistic regression,receiver operating characteristic curve analysis,and independent samples t-test were performed to identify the risk factors for SFFFH.RESULTS Based on the results of logistic regression,age[odds ratio(OR):1.33;95%confidence interval(95%CI):1.12-1.65;P=0.0031]and treatment timing(OR:0.86;95%CI:0.75-0.96;P=0.015)could be considered as the indicators for SFFFH.AVcen(P=0.0334),AASA(P=0.0002),NSA(P=0.0007),and IIA(P=0.0316)were considered to have statistical significance.Further,AVcen(OR:1.41;95%CI:1.04-1.95)and AASA(OR:1.44;95%CI:1.21-1.77),especially AASA(area under curve:66.6%),should be paid much more attention due to the higher OR than other indicators.CONCLUSION We have for the first time unveiled that AASA and age could be key risk factors for SFFFH,which further verifies that deficient anterior coverage of the acetabulum might be the main cause of SFFFH.

Middle-term follow-up results of Pipkin type Ⅳ femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

Purpose： To investigate the mid-term curative effects of the treatment of Pipkin type Ⅳ femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice. Methods： From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years （range, 20 -65 years）. The causes of the fractures included traffic accidents （13 cases）, falls from a height （four cases）, heavy lifting injuries （three cases）, and sport injury （one case）. All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction. Results： The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36-76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%. Conclusion： The mid-term curative effects of a reconstruction plate and bioabsorbable screws in the treatment of Pipkin type IV femoral head fractures is significant, and such the treatment can significantly improve the patient＇s joint function and quality of life.

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients