Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Relevance of the Watson-Jones anterolateral approach in the management of Pipkin type II fracture-dislocation: a case report and literature review

  • Nazim Sifi (Orthopaedic and Trauma Surgery Unit, EPH Beni Abbes) ;
  • Ryad Bouguenna (Orthopaedic and Trauma Surgery Unit, EPH Beni Abbes)
  • Received : 2024.01.27
  • Accepted : 2024.04.29
  • Published : 2024.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Femoral head fractures with associated hip dislocations substantially impact the functional prognosis of the hip joint and present a surgical challenge. The surgeon must select a safe approach that enables osteosynthesis of the fracture while also preserving the vascularization of the femoral head. The optimal surgical approach for these injuries remains a topic of debate. A 44-year-old woman was involved in a road traffic accident, which resulted in a posterior iliac dislocation of the hip associated with a Pipkin type II fracture of the femoral head. Given the size of the detached fragment and the risk of incarceration preventing reduction, we opted against attempting external orthopedic reduction maneuvers. Instead, we chose to perform open reduction and internal fixation using the Watson-Jones anterolateral approach. This involved navigating between the retracted tensor fascia lata muscle, positioned medially, and the gluteus medius and minimus muscles, situated laterally. During radiological and clinical follow-up visits extending to postoperative month 15, the patient showed no signs of avascular necrosis of the femoral head, progression toward coxarthrosis, or heterotopic ossification. The Watson-Jones anterolateral approach is a straightforward intermuscular and internervous surgical procedure. This method provides excellent exposure of the femoral head, preserves its primary vascularization, allows for anterior dislocation, and facilitates the anatomical reduction and fixation of the fracture.

Keywords

References

  1. Sen RK, Tripathy SK, Goyal T, et al. Complications and functional outcome of femoral head fracture-dislocation in delayed and neglected cases. Indian J Orthop 2021;55:595-605. https://doi.org/10.1007/s43465-020-00309-x
  2. Hosny H, Mousa S, Salama W. Management of femoral head fracture by Ganz surgical dislocation of the hip. J Orthop Traumatol 2022;23:24.
  3. Sahin V, Karakas ES, Aksu S, Atlihan D, Turk CY, Halici M. Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. J Trauma 2003;54:520-9. https://doi.org/10.1097/01.TA.0000020394.32496.52
  4. Peng SH, Wu CC, Yu YH, Lee PC, Chou YC, Yeh WL. Surgical treatment of femoral head fractures. Biomed J 2020;43:451-7. https://doi.org/10.1016/j.bj.2019.08.004
  5. Henle P, Kloen P, Siebenrock KA. Femoral head injuries: which treatment strategy can be recommended? Injury 2007;38:478-88. https://doi.org/10.1016/j.injury.2007.01.023
  6. Giannoudis PV, Kontakis G, Christoforakis Z, Akula M, Tosounidis T, Koutras C. Management, complications and clinical results of femoral head fractures. Injury 2009;40:1245-51. https://doi.org/10.1016/j.injury.2009.10.024
  7. Kloub M, Holub K, Peml M, Urban J, Latal P. Closed reduction and minimally invasive screw osteosynthesis of Pipkin femoral head fractures. J Appl Biomed 2023;21:1-6. https://doi.org/10.32725/jab.2023.001
  8. Swiontkowski MF, Thorpe M, Seiler JG, Hansen ST. Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures. J Orthop Trauma 1992;6:437-42. https://doi.org/10.1097/00005131-199212000-00008
  9. Guo JJ, Tang N, Yang HL, Qin L, Leung KS. Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures: a systematic review. Int Orthop 2010;34:319-22. https://doi.org/10.1007/s00264-009-0849-3
  10. Wang CG, Li YM, Zhang HF, Li H, Li ZJ. Anterior approach versus posterior approach for Pipkin I and II femoral head fractures: a systemic review and meta-analysis. Int J Surg 2016;27:176-81. https://doi.org/10.1016/j.ijsu.2016.02.003
  11. Scolaro JA, Marecek G, Firoozabadi R, Krieg JC, Routt ML. Management and radiographic outcomes of femoral head fractures. J Orthop Traumatol 2017;18:235-41. https://doi.org/10.1007/s10195-017-0445-z
  12. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001;83:1119-24. https://doi.org/10.1302/0301-620X.83B8.0831119
  13. Bettinelli G, Placella G, Moharamzadeh D, Belluati A, Salini V. Articular femoral head fracture management: a meta-analysis of literature. Indian J Orthop 2021;55(Suppl 2):304-13. https://doi.org/10.1007/s43465-021-00431-4
  14. Mostafa MF, El-Adl W, El-Sayed MA. Operative treatment of displaced Pipkin type I and II femoral head fractures. Arch Orthop Trauma Surg 2014;134:637-44. https://doi.org/10.1007/s00402-014-1960-5
  15. Steffen R, O'Rourke K, Gill HS, Murray DW. The anterolateral approach leads to less disruption of the femoral head-neck blood supply than the posterior approach during hip resurfacing. J Bone Joint Surg Br 2007;89:1293-8. https://doi.org/10.2106/00004623-200706000-00018