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 wi...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.展开更多
BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized w...BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized with controversial results;surgical hip dislocation(SHD)is among these approaches,with the reputation of being demanding and leading to higher complication rates.AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.METHODS Major databases including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs.We extracted basic studies data,surgery-related data,functional outcomes,radiological outcomes,and postoperative complications.We calculated the mean differences for continuous data with 95%confidence intervals for each outcome and the odds ratio with 95%confidence intervals for binary outcomes.P<0.05 was considered significant.RESULTS Our search retrieved nine studies meeting our inclusion criteria,with a total of 129 FHFs.The results of our analysis revealed that the average operation time was 123.74 min,while the average blood loss was 491.89 mL.After an average followup of 38.4 mo,a satisfactory clinical outcome was achieved in 85%of patients,ranged from 30%to 86%,with avascular necrosis,heterotopic ossification,and osteoarthritis being the most common complications occurring at an incidence of 12%,25%,and 16%,respectively.Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4%and 3.8%,respectively.CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis,the formation of heterotopic ossification,and the development of posttraumatic osteoarthritis;however,it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.展开更多
Objective To discuss the treatment of the hip joint dislocation combined with femoral head fracture and its clinical therapeutic effects.Methods From July 2001 to July 2008,19 patients with hip joint dislocation combi...Objective To discuss the treatment of the hip joint dislocation combined with femoral head fracture and its clinical therapeutic effects.Methods From July 2001 to July 2008,19 patients with hip joint dislocation combined with femoral head fracture underwent conservative therapy or surgical treatment.Classification was based on Pipkin's criteria,type Ⅰ four,type Ⅱ six,type Ⅲ six,type Ⅳ three.Various procedures were taken according to the different types of the fracture,the time of the fracture,and the age of the patients.The clinical therapeutic effects were analyzed.Results In type Ⅰ,four were rated as excellent by Harris Hip Score's criteria.In type Ⅱ,two rated as excellent,three as good and one as fair.In type Ⅲ,three rated as good,two as fair and one as poor.In type Ⅳ,one rated as excellent,one as good and one as fair,overall rate of excellent and good was 73.7%.Conclusion The treatment of Pipkin fracture should be based on multiple factors such as the type of fracture,the time of fracture,the age of patients and so on.The prognosis is directly related with those factors and the way of the treatment.展开更多
目的股骨头骨折是一种常伴有不良预后的少见损伤。本研究回顾性分析笔者所在医院收治的10例股骨头骨折患者,并对临床疗效和预后进行了评估和分析。方法我们回顾性分析了2012年1月—2022年12月期间于我院诊治的股骨头骨折患者10例。男性8...目的股骨头骨折是一种常伴有不良预后的少见损伤。本研究回顾性分析笔者所在医院收治的10例股骨头骨折患者,并对临床疗效和预后进行了评估和分析。方法我们回顾性分析了2012年1月—2022年12月期间于我院诊治的股骨头骨折患者10例。男性8例(80%),女性2例(20%),平均年龄为46.4岁。根据Pipkin的分类,PipkinⅠ型5例,PipkinⅡ型2例,PipkinⅢ型1例,PipkinⅣ型2例。治疗方法分为非手术、手术切开复位内固定术和全髋关节置换术(Total Hip Replacement,THR)三种。术后随访时间平均13个月,我们记录了相关的并发症,并使用改良Harris髋关节评分(Modifed Harris Hip Score,MHHS)评估髋关节功能情况。结果10例患者,5例进行了保守治疗,5例进行了手术治疗,其中1例进行了THR手术治疗。在随访过程中,10例患者4例获得了骨折处良好的愈合,均为PipkinⅠ型股骨头骨折保守治疗患者。1例保守治疗患者并发了髋部创伤性骨关节炎,1例患者复查过程中并发了股骨头坏死,1例患者术后并发了坐骨神经损伤合并手术切口浅层感染,经过治疗后好转,6个月后并发了髋部创伤性关节炎,1例患者并发了创伤性关节炎合并异位骨化,1例患者并发了异位骨化。MHHS评分临床结果为优3例(30%),良3例(30%),一般2例(20%),差2例(20%)。1例预后不佳的患者发展为股骨头坏死后于他院进行了THR手术治疗。结论我们的回顾性分析结果表明,股骨头骨折通常是预后较差的一种骨折类型,目前针对其治疗仍无统一的标准,同时预后仍存在股骨头坏死、创伤性关节炎和异位骨化等并发症可能,随着Pipkin分型从I到IV型,并发症及不良预后发生率逐渐增高。展开更多
文摘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.
文摘BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized with controversial results;surgical hip dislocation(SHD)is among these approaches,with the reputation of being demanding and leading to higher complication rates.AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.METHODS Major databases including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs.We extracted basic studies data,surgery-related data,functional outcomes,radiological outcomes,and postoperative complications.We calculated the mean differences for continuous data with 95%confidence intervals for each outcome and the odds ratio with 95%confidence intervals for binary outcomes.P<0.05 was considered significant.RESULTS Our search retrieved nine studies meeting our inclusion criteria,with a total of 129 FHFs.The results of our analysis revealed that the average operation time was 123.74 min,while the average blood loss was 491.89 mL.After an average followup of 38.4 mo,a satisfactory clinical outcome was achieved in 85%of patients,ranged from 30%to 86%,with avascular necrosis,heterotopic ossification,and osteoarthritis being the most common complications occurring at an incidence of 12%,25%,and 16%,respectively.Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4%and 3.8%,respectively.CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis,the formation of heterotopic ossification,and the development of posttraumatic osteoarthritis;however,it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.
文摘Objective To discuss the treatment of the hip joint dislocation combined with femoral head fracture and its clinical therapeutic effects.Methods From July 2001 to July 2008,19 patients with hip joint dislocation combined with femoral head fracture underwent conservative therapy or surgical treatment.Classification was based on Pipkin's criteria,type Ⅰ four,type Ⅱ six,type Ⅲ six,type Ⅳ three.Various procedures were taken according to the different types of the fracture,the time of the fracture,and the age of the patients.The clinical therapeutic effects were analyzed.Results In type Ⅰ,four were rated as excellent by Harris Hip Score's criteria.In type Ⅱ,two rated as excellent,three as good and one as fair.In type Ⅲ,three rated as good,two as fair and one as poor.In type Ⅳ,one rated as excellent,one as good and one as fair,overall rate of excellent and good was 73.7%.Conclusion The treatment of Pipkin fracture should be based on multiple factors such as the type of fracture,the time of fracture,the age of patients and so on.The prognosis is directly related with those factors and the way of the treatment.
文摘目的股骨头骨折是一种常伴有不良预后的少见损伤。本研究回顾性分析笔者所在医院收治的10例股骨头骨折患者,并对临床疗效和预后进行了评估和分析。方法我们回顾性分析了2012年1月—2022年12月期间于我院诊治的股骨头骨折患者10例。男性8例(80%),女性2例(20%),平均年龄为46.4岁。根据Pipkin的分类,PipkinⅠ型5例,PipkinⅡ型2例,PipkinⅢ型1例,PipkinⅣ型2例。治疗方法分为非手术、手术切开复位内固定术和全髋关节置换术(Total Hip Replacement,THR)三种。术后随访时间平均13个月,我们记录了相关的并发症,并使用改良Harris髋关节评分(Modifed Harris Hip Score,MHHS)评估髋关节功能情况。结果10例患者,5例进行了保守治疗,5例进行了手术治疗,其中1例进行了THR手术治疗。在随访过程中,10例患者4例获得了骨折处良好的愈合,均为PipkinⅠ型股骨头骨折保守治疗患者。1例保守治疗患者并发了髋部创伤性骨关节炎,1例患者复查过程中并发了股骨头坏死,1例患者术后并发了坐骨神经损伤合并手术切口浅层感染,经过治疗后好转,6个月后并发了髋部创伤性关节炎,1例患者并发了创伤性关节炎合并异位骨化,1例患者并发了异位骨化。MHHS评分临床结果为优3例(30%),良3例(30%),一般2例(20%),差2例(20%)。1例预后不佳的患者发展为股骨头坏死后于他院进行了THR手术治疗。结论我们的回顾性分析结果表明,股骨头骨折通常是预后较差的一种骨折类型,目前针对其治疗仍无统一的标准,同时预后仍存在股骨头坏死、创伤性关节炎和异位骨化等并发症可能,随着Pipkin分型从I到IV型,并发症及不良预后发生率逐渐增高。
