Objective: To summarize the short-term effectiveness of type IV Pipkin fracture through transtrochanteric approach with trochanteric osteotomy.
Methods: Between January 2007 and January 2010, 15 cases of type IV Pipkin fracture were treated through transtrochanteric approach with trochanteric osteotomy. There were 9 males and 6 females with an average age of 42.5 years (range, 27-55 years). The causes of fractures included traffic accident (12 cases), falling from height (2 cases), and heavy pound injury (1 case). The time from injury to hospitalization was 4 hours to 7 days (mean, 2.3 days). All patients had limitation of activity in the injured hips. The X-ray films and CT three-dimensional reconstruction indicated posterior dislocation of the hip joints and fractures of the femoral head and acetabulum, with no fracture of femoral neck. The locations of the femoral head fractures were under the round ligament in 9 cases and above the round ligament in 6 cases. Complications were treated firstly in all patients. The time from hospitalization to operation ranged from 2 to 10 days (mean, 4.5 days).
Results: All patients got primary wound healing with no early complication. All the patients were followed up 12-48 months with an average of 26 months. All osteotomies and acetabular fractures healed within 6 to 8 weeks. All patients achieved healing of femoral head fracture after 6-10 months. Mild heterotopic ossification occurred in 2 cases at 3 months after operation which were left untreated; and necrosis of the femoral head occurred in 1 case at 8 months after operation, was treated by total hip arthroplasty. At last follow-up, the flexion of the injuried hips ranged from 60 to 120 degrees (mean, 92.5 degrees). Based on Thompson et al. scoring scales, the results were excellent in 5 cases, good in 7 cases, fair in 2 cases, and poor in 1 case; the excellent and good rate was 80%.
Conclusion: Treatment of type IV Pipkin fracture through transtrochanteric approach with trochanteric osteotomy can provide good visualization and protection of the blood supply of the femoral head.