Using an Intraoperative Stress Examination to Direct Treatment in Posterior Femoral Head Fracture-Dislocations

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Hip joint biomechanics

Background:

• Femoral head fractures from posterior hip dislocations present complex challenges in surgical management.
• Determining the necessity for posterior wall or capsule repair after initial fixation is critical for optimal outcomes.

Purpose of the Study:

• To evaluate a treatment algorithm using intraoperative examination under anesthesia (EUA) after femoral head fixation.
• To assess the efficacy of EUA in identifying the need for posterior wall or capsule repair in traumatic hip dislocations.

Main Methods:

• Retrospective review of acute, traumatic femoral head fractures from posterior hip dislocations at two Level 1 trauma centers (2017-2022).
• Injuries were classified using the Pipkin system.
• Primary outcome: intraoperative EUA results post-femoral head fixation to guide Kocher-Langenbeck exposure for posterior repair.

Main Results:

• Of 85 patients, 92.9% achieved stable EUA after Smith-Petersen fixation, avoiding additional Kocher-Langenbeck procedures.
• Six patients (7.1%) required additional posterior approach, including Pipkin I, II, and IV injuries.
• Rates of avascular necrosis (26.4%), heterotopic bone formation (32.3%), and conversion to total hip arthroplasty (10.8%) were observed.

Conclusions:

• Intraoperative EUA after femoral head fixation is effective in detecting residual posterior hip instability.
• The Smith-Petersen approach combined with EUA is a viable option for managing these complex fractures.
• EUA aids in decision-making for posterior wall or capsule repair, irrespective of Pipkin classification or posterior wall involvement.