[All-arthroscopic reduction and fixation of Pipkin type Ⅰ and Ⅱ femoral head fractures]

To investigate the effectiveness of all-arthroscopic treatment for Pipkin type Ⅰ and Ⅱ femoral head fractures.

A retrospective analysis was conducted on the clinical data of 13 patients with Pipkin type Ⅰ and Ⅱ femoral head fractures who underwent all-arthroscopic reduction and fixation between May 2015 and May 2024. The cohort included 10 males and 3 females, with an average age of 27.4 years (range, 14-40 years). The mechanisms of injury involved traffic accidents in 11 cases and falls from a height in 2 cases. According to the Pipkin classification, there were 7 type Ⅰ and 6 type Ⅱ fractures. Seven patients presented with concomitant posterior hip dislocation. The interval from injury to surgery ranged from 1 to 10 days, averaging 3.2 days. Fixation was achieved using bioabsorbable suture anchors in 7 cases, bioabsorbable screws in 4 cases, and Herbert screws in 2 cases. Key parameters including operation time, intraoperative blood loss, complications, and fracture healing time were recorded. At last follow-up, hip joint function was evaluated using the Harris hip score and the Thompson-Epstein evaluation criteria.

The operation time ranged from 100 to 140 minutes, with an average of 119.5 minutes. The intraoperative blood loss ranged from 20 to 65 mL, with an average of 40.8 mL. No postoperative complication such as neurovascular injuries occurred, and all incisions healed by primary intention. All 13 patients were successfully followed up 9-24 months, with an average of 16 months. The fracture healing time ranged from 10 to 18 weeks, averaging 14.1 weeks. During the follow-up, no complication such as traumatic osteoarthritis, osteonecrosis of the femoral head, heterotopic ossification, or internal fixation failure was observed. At last follow-up, the Harris hip score ranged from 91 to 97, averaging 94.6. Based on the Thompson-Epstein criteria, the clinical outcomes were graded as excellent in 9 cases and good in 4 cases, with an excellent and good rate of 100%.

For Pipkin type Ⅰ and Ⅱ femoral head fractures, all-arthroscopic fixation represents a safe and effective therapeutic strategy. The individualized selection of Herbert screws, bioabsorbable screws, or suture anchors based on the specific characteristics of the fracture fragments offers significant clinical advantages. This approach ensures minimal invasiveness, minimal disruption of the femoral head blood supply, and a low complication rate.