Irreducible Pipkin II femoral head fractures: Is transgluteal approach the best strategy? - 04/10/10

Doi : 10.1016/j.otsr.2010.04.011

A.-P. Uzel ^a,^⁎ , G.-Y. Laflamme ^b, J.-L. Rouvillain ^c
^a Department of Orthopaedic Surgery and Traumatology, Pointe-à-Pitre Teaching Hospital Center, Route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe
^b University of Montreal, Division of Orthopaedic Surgery, Sacré-Coeur Hospital, 5400 Gouin Ouest, Local J-3245, Montreal, H4J 1C5 Quebec, Canada
^c Department of Orthopaedic Surgery and Traumatology, La Meynard Teaching Hospital Center, 97200 Fort-de-France, Martinique

Corresponding author. Tel.: +33 5 90 89 14 66, Secretary office: +33 5 90 89 10 10x3461; fax: +33 5 90 89 17 44.

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Summary

Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment.