The Efficacy of Trochanteric Flip Osteotomy in Cases of Femoral Head Fracture

Kyung-Jae Lee; Byung-Woo Min; Hyub Sakong; Young-Jae Lim; Kyung-Keun Min; Jong-Hyuk Jeon

doi:10.4055/jkoa.2013.48.3.205

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Lee, Min, Sakong, Lim, Min, and Jeon: The Efficacy of Trochanteric Flip Osteotomy in Cases of Femoral Head Fracture

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(3): 205-212.

Published online: 24 June 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.3.205

The Efficacy of Trochanteric Flip Osteotomy in Cases of Femoral Head Fracture

Kyung-Jae Lee, M.D., Byung-Woo Min, M.D., Hyub Sakong, M.D., Young-Jae Lim, M.D., Kyung-Keun Min, M.D., Jong-Hyuk Jeon, M.D.

Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu, Korea.

Correspondence to: Byung-Woo Min, M.D. Department of Orthopedic Surgery, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. TEL: +82-53-250-7267, FAX: +82-53-250-7205, min@dsmc.or.kr

Received 16 January 2013 Revised 7 February 2013 Accepted 25 March 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the clinical and radiological results of the trochanteric flip osteotomy in cases of femoral head fractures.

Materials and Methods

Between May 2000 and January 2012, we evaluated 14 cases of femoral head fractures treated by trochanteric flip osteotomy in combination with the Kocher-Langenbeck approach after a minimum follow-up of one year. There were 13 men and one woman and the average follow-up period was 36.4 months. The clinical results were evaluated according to Merle d'Aubigne-Postel scores and the Thompson-Epstein scoring scale and the radiological results were evaluated according to time to union of fractures and osteotomy site. We also evaluated the incidence of complications.

Results

At the last follow-up, mean Merle d'Aubigne-Postel score was 16.4 and 11 cases out of 14 patients presented with good to excellent, two cases presented with fair, and one case presented with a poor clinical result according to the Thompson-Epstein scoring scale. Radiologically all cases achieved union of fractures and osteotomy site and the mean time to union of the osteotomy site was 7.9 weeks. Complications included one case of heterotopic ossification which did not disturb hip function, two cases of avascular necrosis of the femoral head, and one case of post-traumatic osteoarthritis.

Conclusion

The trochanteric flip osteotomy in the case of a femoral head fracture showed good clinical and radiological results through good visualization and accurate reduction of the fracture site. However, conduct of further studies including larger number of patients is needed in order to evaluate the incidence of complications such as avascular necrosis of the femoral head.

Keywords: femur head, fracture, osteotomy

Figures and Tables

Figure 1

Diagram shows the surgical technique of the trochanteric flip osteotomy. (A) Patient lies in the lateral decubitus position on the operating table and the Kocher-Langenbeck approach is used. (B) As oscillating saw is used for the trochanteric flip osteotomy. The majority of the gluteus medius tendon is attached proximally and the insertion of the vastus lateralis muscle is attached distally at the fragment. (C) Exposure of the capsule and posterosuperior acetabular wall is achieved with anterior flipping of the osteotomized trochanteric fragment. (D) For dislocation of the femoral head, the hip is flexed, externally rotated, and the leg is brought over the front of the operating table and placed in a sterile bag. (E) After dislocation of the femoral head, the fracture can be easily visualized, reduced and stabilized. GT, greater trochanter; Gmed, gluteus medius; Vlat, vastus lateralis; P, piriformis muscle; OI, obturator internus; Q, quadratus femoris; Pw, posterosuperior acetabular wall; C, capsule; FH, femoral head; Ace, acetabulum.

Figure 2

(A) Preoperative anteroposterior pelvic radiograph of a 33 year-old male shows the femoral head fracture of Pipkin type IV. (B) Postoperative radiograph shows an anatomic reduction and internal fixation with headless screws, spring plates. (C) Radiograph obtained at postoperative 23 months shows union of the fracture and osteotomy site. There is no evidence of avascular necrosis of the femoral head or posttraumatic osteoarthritis.

Figure 3

(A) Preoperative anteroposterior pelvic radiograph shows the femoral head fracture of Pipkin type IV. (B) Postoperative radiograph shows an anatomic reduction and internal fixation with headless screws, spring plates. (C) Radiograph obtained postoperative 34 months shows avascular necrosis of the femoral head.

Table 1

Patient Demographics and Results

M, male; F, female; MVA, motor vehicle accident; GT, greater trochanter; OA, osteoarthritis; AVN, avascular necrosis; HO, heterotopic ossification; Fx., fracture; PCL, posterior cruciate ligament; ACL, anterior cruciate ligament; MCL, medial collateral ligament.

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