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Hip Arthroscopy-Assisted Management of Pipkin Types I and II Femoral Head Fracture-Dislocations: Mid-Term Clinical
Shan-Ling Hsu1, Chi-Hsiang Hsu1, Chin-Yi Liao2
1The Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Objectives:
Hip arthroscopy-assisted surgery has been proposed as a minimally invasive option for femoral head fractures; however, evidence with mid-term follow-up remains limited. This study aimed to evaluate the clinical and radiographic outcomes of arthroscopy-assisted management for Pipkin Types I and II femoral head fracture-dislocations with a minimum follow-up of 5 years.
Methods:
This retrospective study included 23 consecutive adults (19 Pipkin I and 4 Pipkin II) treated with hip arthroscopy-assisted fragment excision or internal fixation between March 2013 and January 2020. Preoperative computed tomography was used for surgical planning, and fixation was placed with arthroscopic headless screws. Clinical outcomes were assessed using the Harris Hip Score (HHS) and Thompson-Epstein (T-E) criteria. Radiographic evaluation included avascular necrosis (AVN), heterotopic ossification (HO; Brooker), osteoarthritis (OA; Tönnis), and fracture reduction quality (Matta's criteria). Group comparisons were evaluated using independent samples t-tests, Mann-Whitney U tests, and Fisher's exact test. The mean follow-up was 86.2 ± 21.2 months.
Results:
The cohort consisted of 19 males and 4 females with a mean age of 28.7 ± 9.9 years. Fifteen patients underwent fixation and eight underwent excision. The final mean HHS was 98.3 ± 1.9, with 21 patients (91%) achieving excellent and 2 (9%) good T-E criteria. There were no significant differences between the fixation and excision groups in demographic characteristics, operative time, or functional outcomes (all p > 0.05); however, hospital stay was significantly shorter in the excision group (2.9 ± 0.6 vs. 5.5 ± 4.6 days, p = 0.028). In the fixation group, mean maximal displacement improved from 7.6 mm preoperatively to 2.6 mm postoperatively, with anatomic reduction achieved in 6 cases (40%), imperfect in 6 (40%), and poor in 3 (20%). Patients with Pipkin Type I fractures had significantly higher HHS than those with Type II fractures (98.7 ± 1.7 vs. 96.0 ± 0.8, p = 0.018). Complications were rare, with one case of Brooker Grade I HO and one case of mild OA. No AVN or total hip arthroplasty occurred during the follow-up.
Conclusions:
Hip arthroscopy-assisted management of selected Pipkin Type I and II femoral head fractures yields excellent mid-term clinical outcomes with acceptable radiographic reduction and a low complication rate. This minimally invasive technique represents a viable alternative in appropriately selected patients when fragment characteristics and surgical expertise permit.
Insights
Hip arthroscopy-assisted surgery for Pipkin Type I and II femoral head fractures shows excellent mid-term clinical outcomes. This minimally invasive approach offers a viable alternative with a low complication rate for selected patients.
Area of Science:
- Orthopedic Surgery
- Minimally Invasive Procedures
- Trauma Management
Background:
- Femoral head fractures require effective treatment to prevent long-term complications.
- Hip arthroscopy-assisted surgery is a minimally invasive option, but mid-term data are limited.
- Pipkin Types I and II fractures are specific intra-articular hip injuries.
Purpose of the Study:
- To evaluate the clinical and radiographic outcomes of arthroscopy-assisted management for Pipkin Types I and II femoral head fractures.
- To assess mid-term results with a minimum follow-up of 5 years.
- To compare fragment excision versus internal fixation outcomes.
Main Methods:
- Retrospective study of 23 adult patients (19 Pipkin I, 4 Pipkin II) treated between 2013-2020.
- Arthroscopy-assisted fragment excision or internal fixation using headless screws.
- Clinical assessment via Harris Hip Score (HHS) and Thompson-Epstein (T-E) criteria; radiographic evaluation for AVN, HO, OA, and reduction quality.
Main Results:
- Excellent mid-term outcomes: mean HHS 98.3, 91% excellent T-E criteria.
- No significant difference in functional outcomes between fixation and excision groups (p>0.05).
- Pipkin Type I fractures showed significantly higher HHS than Type II (p=0.018); low complication rates (HO, mild OA), no AVN or THA.
Conclusions:
- Arthroscopy-assisted management of selected Pipkin Type I and II femoral head fractures provides excellent mid-term clinical results.
- The technique demonstrates acceptable radiographic reduction and a low complication profile.
- This minimally invasive approach is a viable option for appropriately selected patients with suitable fragment characteristics and surgical expertise.