Abstract
BackgroundFemoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity.Patients and methodsBetween 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d’Aubigne scores. The reduction of the fracture was evaluated according to Matta’s criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented.ResultsTwelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25–48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d’ Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1).ConclusionsThe 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications.Trial registrationWe register our research at http://www.researchregistry.com. The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847.
Highlights
Fracture of the femoral head was described by Birkett [1] in 1869 firstly, who found this fracture during dissection of a cadaver
Park et al [3] found traffic accidents accounted for 93.9% of femoral head fractures, Kelly and Yarbrough [4] suggested an incidence of 92.6% and Pipkin [5] reported traffic accidents as the cause of femoral head fractures in about 92% of all such fractures
Using 3D printed model, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics
Summary
Fracture of the femoral head was described by Birkett [1] in 1869 firstly, who found this fracture during dissection of a cadaver. About 5~15% of posterior hip dislocations have been reported to be associated with femoral head fractures [7]. There is still no consensus on the management of injuries: whether to treat these fractures operatively or non-operatively, whether to fix or excise the head fragment, or which surgical approach to use. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. The optimal surgical approach for the treatment of femoral head fracture remains controversial. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity
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