Safe Surgical Dislocation Research Articles

Posterior approaches to the acetabulum.

Posterior approaches, particularly the Kocher-Langenbeck approach, remain the workhorses in the treatment of acetabular fractures. Various modifications have been developed, each offering specific advantages depending on surgical requirements. The modified Gibson approach, for example, is suggested to provide enhanced visualization of the superior acetabulum, although recent cadaveric studies have not consistently substantiated this benefit. The Ganz approach, which involves bigastric trochanteric osteotomy with safe surgical hip dislocation, is particularly advantageous for managing complex and comminuted posterior acetabular fractures, as it enables a 360° view of the acetabulum and femoral head. Overall, posterior approaches are associated with low rates of complications, with heterotopic ossification being the most prevalent. The choice of surgical approach and patient positioning should be guided by the surgeon's preference and expertise, tailored to the specific fracture pattern and patient characteristics.

Outcomes of Intra-Articular Procedures through Safe Surgical Hip Dislocation Approach to Manage Residual Hip Deformities Secondary to Legg-Calv-Perthes Disease: A Systematic Review and Meta-Analysis

Abstract Background Legg-Calve-Perthes disease (LCPD) is a childhood condition characterized by femoral head osteonecrosis. The osteonecrotic lesion eventually heals, but persistent deformity to the proximal femur and acetabulum might induce hip discomfort and dysfunction following recovery. Previous reports have noted that between 30% and 50% of individuals affected by LCPD to have residual hip symptoms that persist and a frequent precursor to hip osteoarthritis in young adulthood. Aim of the Work The aim of the present study is to review the efficacy of intra-articular procedures through surgical hip dislocation approach to residual hip deformity secondary to Legg- Calve-perthes disease. Patients and Methods A Systematic Review and Meta-Analysis, We will include: Randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies and we will exclude: case reports, case series studies, cross sectional studies and non English studies. Results The surgical hip dislocation approach allows the surgeon to dynamically evaluate the hip, identify sources of impingement, and treat intraarticular and extraarticular abnormalities. Conclusion Head and neck osteochondroplasty performed through the surgical dislocation approach, combined with other procedures such as FHRO, RFNL, ITO and acetubular osteotomies relieved pain, improved ROM and restored function in most patients with no major complications.

Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)

Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and preteens who are still growing. Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. Without early detection and proper treatment, SCFE can lead to potentially serious complications, including rapid degeneration of the femoral head and/or painful arthritis in the hip joint. Objective. Our case is presented to familiarize with the technique of safe surgical hip dislocation for the treatment of intraarticular hip pathologies. Case report and Methods. After collision while playing the 11 year old girl developed left hippain still allowing to walk. Imaging documented an acute slipped femoral capital epiphysis with the metaphysis articulating against the acetabulum. The patient was underwent open reduction could be performed using the DUNN procedure modified by GANZ. 6 weeks later prophylactic screw stabilization of the healthy right hip followed. Results. At 9 months follow-up the patient walks painfree with symmetric range of motion. Conclusion. The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery. Early diagnosis of SCFE provides the best chance of stabilizing the hip and avoiding complications. When treated early and appropriately, long-term hip function can be expected to be very good. Once SCFE is confirmed, the child will not be allowed to put weight on their hip and will be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours. In patients with unstable SCFE, the surgeon may first make an open incision in the hip, then gently manipulate (reduce) the head of the femur back into its normal anatomic position. The surgeon will then insert one or two metal screws to hold the bone in place until the growth plate closes. Sometimes surgeon may recommend inserting a screw into the unaffected hip at the same time to reduce the risk of SCFE. Our case demonstrates the value of open reduction of a severely dislocated femoral capital epiphysis in a case otherwise probably needing endoprosthetic hip replacement for restitution of hip function or hip arthrodesis at short-term follow-up

Functional, Oncological, and Radiological Outcomes Following Safe Surgical Dislocation for the Treatment of Locally Aggressive Proximal Femoral Lesions

Abstract Study Type: Retrospective cohort study. Background and Purpose: Locally aggressive lesions of the proximal femur represent a spectrum of pathologies in the younger age group, which result in large defects. Safe surgical dislocation (SSD) is one of the viable surgical approaches to achieve optimal visualization and clearance of tumor. This study looks at the functional, oncological, and radiological outcomes following SSD for the treatment of locally aggressive proximal femoral lesions. Materials and Methods: A retrospective study was done in Orthopedics Unit 3 at our tertiary care center between 2015 and 2021 on patients who underwent SSD for the treatment of biopsy confirmed locally aggressive proximal femur lesions. The inclusion criteria were age more than 15 years, with biopsy confirmed symptomatic locally aggressive lesions of the proximal femoral region with a minimum 1 year follow-up. The clinical parameters were reduction in pain, restoration of hip movements, abductor strength, and ability to weight bear and resumption of activities of daily living. Graft consolidation, status of implant, local recurrence, trochanteric nonunion, and appearance of avascular necrosis included as radiological parameters. The functional parameters were assessed through the modified Musculoskeletal Tumor Society Score and the nonarthritic Young Hip Score. Results: Ten cases of biopsy-proven proximal femoral lesions (out of 15 such cases) fulfilling the inclusion criteria were enrolled. All ten underwent intralesional excision/extended curettage of lesion, followed by auto/allograft reinforcement to fill the defect and internal fixation using SSD as surgical approach. The choice of graft and fixation method was based on surgeon’s preference. Functional and radiographic assessment was done on follow-up, with an average follow-up of 13 months (range 12–14 months). The mean nonarthritic Young Hip Score improved from 49 (±8.96) preoperatively to 85.4 (±11.95) at the time of review, and the modified Musculoskeletal Tumor Society Score improved from a mean of 23.3 (±0.83) preoperatively to 28.4 (±1.07) at the time of review. There was no tumor recurrence and avscular necrosis at the time of follow-up. Allograft consolidation was seen in 8 out of 10 cases at the time of review. Conclusion: SSD is an excellent approach to achieve optimal tumor clearance. Good functional and radiological outcomes are seen if adequate tumor clearance is obtained and reconstruction with stable internal fixation is achieved. Tumor recurrence and avascular necrosis were not noted in any of the cases at 1-year (intermedial) follow-up.

How Safe and Technical Is Modified Dunn Osteotomy in the Management of Patients with SCFE: A Clinical Trial with Short-Term Follow-Up

Objective. Over the last decade, modified Dunn osteotomy has been widely used in the management of slipped capital femoral epiphysis (SCFE) with varying degrees of complications. Different conclusions have been adopted. Our study represented our experience in using such a technique in stable and unstable SCFE and tried to determine its safety and applicability for routine practice. Methods. Our study adopted an interventional prospective design performed on 24 hips divided evenly between both sexes with a mean age of 13.25. On the Southwick classification, the cases were distributed between moderate and severe, which constituted 41.7% and 58.33%, respectively. Three quarters of the study subjects were stable according to the Loder classification. Each underwent modified Dunn osteotomy after a safe surgical hip dislocation. Results. Over the period of about 1-year follow-up, clinical evaluation was performed by examining the surgical site and assessing the legs’ length, range of hip movement, Harris hip score, and iHOT-12 score. Radiological assessment was performed by calculation of slip angle from the frog lateral view, assessment of union, and occurrence of any complications. The study showed that there was significant improvement in patients in terms of radiological and clinical outcomes, with the occurrence of AVN in 16.7% of cases (4 out of 24). All cases of AVN occurred in unstable hips. Conclusion. Despite the complication of AVN, we believe the results of this study add to the current literature which suggests that modified Dunn osteotomy is an effective and safe technique for the management of moderate and severe SCFE. This trial is registered with PACTR202312819351504.

Functional outcome of type 4 Pipkin classification of femoral head fracture operated by open reduction internal fixation by ganz safe surgical dislocation approach management: a case report

Fracture of the femoral head is a severe, relatively uncommon injury; typically, it may have associated with traumatic posterior dislocation of the hip joint with or without acetabulum fracture. The Pipkin classification is the most commonly used classification system. Controversies include the preferred surgical approach (anterior versus posterior) versus ganz safe surgical dislocation approach and whether to perform femoral head fragment excision or internal fixation. Presenting a case report of 28 years old young male with a motor vehicle road traffic accident and suffered a head of femur fracture on right hip joint with posterior wall of right acetabulum fracture with Judet-Letournel type posterior wall and type 4 Pipkin’s classification of femoral head fracture. This patient was undergone for emergency surgical intervention of open reduction, internal fixation through Ganz approach and insertion of Herbert screws for femoral head and interfragmentary screw for trochanteric osteotomy. The patient was followed up for 1 year and have a complete range of motion at hip joint with painless daily lifestyle. Type 4 Pipkin classification of femoral head fracture managed timely and with surgical intervention by ganz safe surgical dislocation approach provides visualization to femoral head and whole acetabulum with internal fixation of femur head by herbert screw which preserves normal anatomic contour of femoral head shows appropriate reduction of fracture fragments and it may also avoid hemiarthroplasty surgeries. Fracture of the femoral head has been associated with a relatively poor functional outcome and requires timely management and surgical intervention. Specially type 4 Pipkin classification of femoral head fracture treated by ganz safe surgical dislocation approach with internal fixation of femur head by herbert screw shows better outcome and avoid risk of AVN of femoral head. Complications associated with fracture of the femoral head and subsequent treatment include osteonecrosis, post-traumatic osteoarthritis, heterotopic ossification and implant failure.

Hip Joint Instability After Surgery Performed Through the Surgical Dislocation Approach.

Safe surgical dislocation of the hip is a versatile approach to the hip joint with a low complication rate. Hip joint instability is a devastating complication with poor prognosis. All hips treated surgically through the safe surgical dislocation approach were entered in a database and the complication of hip joint instability was studied prospectively from 2000 to 2021. Instability was diagnosed by intraoperative stress examination and on postoperative radiographs. The initial deformities treated, type of instability, presumed causes, treatment provided, response to the treatment, and final result were recorded as they happened during the course of the treatment. We considered patient's age, sex, body mass index (BMI), and initial diagnosis as risk factors. We evaluated the radiographs for femoral neck shortening, lack of greater trochanteric advancement, acetabular deformity, and incongruity of the hip joint. Anterior hip precautions were initiated in the middle of the study period. 22/459 hips developed hip joint instability after surgical dislocation approach performed for hip preservation. Acetabular deficiency, coxa breva, coxa valga, posterior impingement, increased anteversion, lax soft tissues, medial thigh obesity and lack of postoperative precautions seemed to contribute to instability. 50% of the hips became normal. Chondrolysis and residual subluxation were common in the others. Surgical dislocation approach disrupts the soft tissue restraints of the hip and joint stability depends on bony morphology, abductor muscle tension, and postoperative precautions. Several risk factors were subjective and speculative, but awareness of all the potential risk factors and prevention and treatment options should decrease this complication. IV Case series.

A Rare Occurrence of Enchondroma in the Head of Femur in an Adult Male: A Case Report

Introduction: Enchondroma is a solitary, benign, and intramedullary cartilaginous tumor occurring most commonly in small bones of hands and feet contributing to 3–10% of all bone tumors. They originate from the growth plate cartilage which later on proliferates to form enchondroma. Lesions are central or eccentric and metaphyseal involvement is most common for long bones. We report a case of atypical occurrence of enchondroma in the head of femur in a young male. Case Report: A 20-year-old male patient presented with a history of pain in the left groin for 5 months. Radiological examination showed a lytic lesion in the head of femur. The patient was managed by safe surgical dislocation of the hip, curettage with autogenous iliac crest bone graft with countersunk screw fixation. Histopathology confirmed the lesion to be enchondroma. At the latest follow-up after 6 months, the patient was symptom-free and there was no evidence of any recurrence. Conclusion: Lytic lesions in the neck femur can have a good prognosis provided timely diagnosis and interventions are done. The present case of enchondroma in the head of femur represents a very rare differential diagnosis for the same and this must be kept in mind. So far, no such case has been reported in the literature. Magnetic resonance imaging and histopathology are of the essence to confirm this entity. Keywords: Enchondroma, atypical presentation, safe surgical dislocation of hip.

English

BACKGROUND High velocity motor vehicle injuries are associated with hip fracture dislocations especially dash board injuries. Most commonly posterior hip dislocations are associated with occasional femoral head fractures. Computerized tomographic imaging is done to look at the congruency of the hip joint. Safe surgical dislocation or Ganz approach was described in 2001 for exposing the hip in a 360-degree view without damaging the vascularity of the femoral head. In this study, we wanted to evaluate the radiological and functional outcome using modified Merle d' Aubigne-Postel and Harris hip scoring. METHODS The current study is a prospective study in a tertiary referral centre where 8 young adult males were followed up for a period of 2 years 6 months from August 2018 to February 2021 after safe surgical dislocation and reduction with headless Herbert screws to maintain congruent hip surface. RESULTS We had 1 patient with associated chest injury requiring intercostal tube placement, while none of them had developed avascular necrosis or early arthritis. We had used modified Merle d'Aubigne-Postel and Harris hip scoring to assess the functional outcome. We had six patients with excellent results and two patients with good outcome due to occasional pain. We followed all the patients for more than 2 years. We evaluated the radiological and functional outcomes. The results are comparable to other researcher’s studies. CONCLUSIONS Safe surgical dislocation is a very good choice for fixation of femoral head fractures where the complications like early arthritis of femoral head and acetabulum are less along with preserving the vascularity of the femoral head and preventing the chances of avascular necrosis of femoral head. It also provides a good intraoperative view for handling the fracture reduction. KEYWORDS Pipkin Fracture, Ganz Approach, Safe Surgical Dislocation Hip, Herbert Screw

Bilateral femoral head reshaping and mosaicplasty in Legg-Calvé-Perthes disease residual deformity.

Residual hip deformity secondary to Perthes disease may lead to early symptomatic joint degeneration. The altered anatomy results in biomechanical and biological problems that can be surgically addressed in adolescents or young adults with hip preservation procedures. This case report aims to demonstrate a customized surgical treatment performed on a 15-year-old male who developed painful hips with significant intra- and extra-articular impingement, secondary to bilateral Leg–Calvé–Perthes disease residual deformity. Intra-articular procedures were executed through a safe surgical dislocation of the hip, with a mosaicplasty using osteochondral autografts from the exceeding peripheral ipsilateral femoral head, a femoral head–neck osteochondroplasty and a labrum repair. A relative lengthening of the femoral neck was also carried out with a trochanteric advancement to solve the extra-articular issues. On follow-up, he referred to a substantial improvement in pain and function, being his radiographic studies satisfactory. At 4 and 5 years from surgery, the patient was able to exercise regularly with minimal complaints, with a Harris Hip Score of 85.85% and a Hip Outcome Score of 94.1% for activities of daily life and 86.1% for sports. In patients with hip deformity after healed Perthes disease, treatment strategies that address both the morphological disturbance of coxa magna, plana and breva, as well as the biological concerns arising from osteochondral injuries or labral tears, and mechanical dysfunctions lead to improvements in symptomatology, function and medium-term prognosis. Further procedures to address residual adaptative acetabular dysplasia would favor outcomes of conservative hip surgery in the sequelae of LCPD.

Reconstruction of the Hip in Multiple Hereditary Exostoses.

The hip joint involvement in multiple hereditary exostoses (MHE) occurs in 30–90%, causing pain and limitation of motion by femoroacetabular impingement, coxa valga, acetabular dysplasia, hip joint subluxation, and osteoarthritis. The purpose of this study was to investigate the clinical and radiographic outcomes of ten hips in seven patients treated by surgical dislocation and corrective osteotomies between 2004 and 2009. Surgical dislocation and excision of the osteochondromas and varus intertrochanteric osteotomies were performed in all cases when the neck–shaft angle was > 150°. Common sites of osteochondromas were medial, posterior, and anterior neck of the femur. Neck–shaft angle of the femur was improved from a mean of 157° to 139°, postoperatively. On an average, the center-edge angle improved from 20° to 30° postoperatively. We believe that Ganz’s safe surgical dislocation technique is the preferred treatment of MHE. This safeguards the circulation of the femoral head and the osteochondromas can be resected under direct vision. It can be combined with additional corrective osteotomies because the hip affected by MHE is frequently associated with dysplastic changes which can result in premature osteoarthritis.

Safe Surgical Dislocation of the Hip in the Management of Pediatric and Adolescent Hip Problems

Safe Surgical Dislocation of the Hip in the Management of Pediatric and Adolescent Hip Problems

Irreducible Femur Head Fracture-Dislocation Treatment With Kocher-Langenbeck Approach With Flip Trochanteric Osteotomy: A Novel Approach.

Femoral head fracture-dislocations are rare, and irreducible cases are even less frequent. Truly irreducible fracture-dislocations must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. The Pipkin classification is commonly used to classify femoral head fractures. An urgent reduction is required in traumatic hip dislocations to reduce the risk of avascular necrosis (AVN) of the femoral head. However, in femoral head fractures, the dislocated hip cannot be reduced easily due to incarcerated bone or soft tissue. In an irreducible fracture hip dislocation, It is not advisable to attempt to reduce it repeatedly because sometimes femoral head fracture-dislocation is associated with the impacted fracture of the femoral neck. It may lead to iatrogenic femoral neck fracture. Hence, in such cases, immediate open reduction and internal fixation are recommended. The Kocher-Langenbeck approach can be used for reduction and safe surgical dislocation with flip trochanteric osteotomy for fixation as a novel approach.

Trochanteric osteotomy for safe surgical approach to bilateral hip dislocations with femoral head fractures

A 23-year old male with bilateral hip dislocations and associated femur head fractures (Pipkin type-II) presented with pain and flexion deformity of both hips after 9 days. After imaging, closed reduction was attempted but failed. Open reduction through Kocher-Langenbeck approach was performed and the femoral head fracture was accessed through Ganz’s safe surgical dislocation. The fracture was reduced anatomically and fixed with headless Herbert screws. After two years, the patient was walking without pain or limp and there was no evidence of osteonecrosis. Simultaneous sequential Ganz’s safe surgical dislocation can be performed in bilateral Pipkin’s fracture dislocation with excellent short term outcome.

The Modified Dunn Procedure for Unstable Slipped Capital Femoral Epiphysis: A Systematic review and Meta-analysis

Abstract Source of Support None, Conflict of Interest None. Background The management of unstable slipped capital femoral epiphysis is controversial and evolving as insight into the condition develops. Almost half of patients with unstable slip developed femoral head osteonecrosis. The modified Dunn procedure through safe surgical hip dislocation has rapidly gained popularity as a treatment for unstable slipped capital femoral epiphysis. In this review we analyzed the results and complications following this procedure. Materials and Methods We performed a retrospective chart review of 297 consecutive patients (302 hips) who had undergone the modified Dunn procedure through safe surgical hip dislocation from Feb 2009 to Feb 2017. Patients were169 males and 128 females, between the age group of 7 to 18 years (mean age 12.66 years) and BMI ranged from 14.7 to 42.1 Kg/m2 (mean BMI 26.32 Kg/m2). The duration of symptoms among the studied group ranged from 2 to 360 days with mean 84.75days. Regarding site and severity 57% had lesions in left side, 40.9% had lesions in right side, 2.1% had bilateral lesions and 58% had severe lesions. The duration of operation among the studied group ranged from 75 to 162 min with mean 128.19 min. Regarding time of operation 61.1% had operation after more than 24 h from admission. All the patients were assessed with slip angle degree, Harris hip score, alpha angle, flexion degree, internal rotation, external rotation and neck shaft angle. Results At the mean follow up of 26.3 months (range 12 months to 4.5 years), the mean slip angle improved from a preoperative Value10 to 80 degree with mean 55.6 degree and after operation it ranged from 0 to 28 degree with mean 6.7 degree with mean reduction 48.9 degree, the Harris hip score among the studied group after operation ranged from 46 to 100% with mean 90.98%, regarding post-operative range of motion alpha angle ranged from 23.6 to 52.8 degree with mean 44.3 degree, flexion ranged from 80 to 120 degree with mean 105.84 degree, internal rotation ranged from 5 to 60 degree with mean 30.08 degree and external rotation ranged from 10 to 60 degree with mean 42.3 degree and finally neck shaft angle ranged from 128 to 164 degree with mean 137.2 degree. Conclusion Unstable slipped capital femoral epiphysis is associated with a high rate of avascular necrosis. Etiology of the AVN is not completely known and likely multifactorial. The modified Dunn osteotomy through Ganz surgical hip dislocation is the treatment of choice for those with moderate and severe unstable SCFE, allowing anatomical restoration of proximal femur, direct inspection, and preservation of physeal blood supply and inspection of intra-articular pathology which can be evaluated and treated at the time of operation.

Trochanteric Flip (Ganz) Anterior Hip Dislocation for Fixation of Pipkin Fracture-Dislocations.

The procedure is performed with use of a conventional Kocher-Langenbeck exposure with the patient in the lateral position. The trochanteric flip is performed, allowing exposure of the anterior capsule, which is incised to dislocate the head anteriorly. Fracture fixation is performed with use of mini-fragment screws followed by relocation of the head, closure of the capsulotomy, and fixation of the osteotomy. Fixation of femoral-head fractures can also be performed with use of alternate surgical approaches. Anterior-based surgical approaches like the Hueter approach or the Smith-Petersen approach are preferred with the goal of preserving the posterior extraosseous blood supply to the femoral head. The posterior Kocher-Langenbeck approach can also be utilized because there is no clear evidence suggesting that a properly performed posterior approach affects the blood supply of the femoral head. Surgical hip dislocation is 1 of the preferred techniques for operative treatment of femoral-head fractures and is a versatile approach that provides circumferential exposure of the femoral head and acetabulum through an anterior dislocation. A compromised blood supply to the femoral head is much less likely with use of this approach compared with posterior-based surgical approaches. Compared with anterior-based surgical approaches, which are often restrictive, surgical dislocation is extensile and provides adequate exposure to treat associated injuries to the acetabulum and the labrum of the hip. Outcomes following surgical dislocation for femoral-head fractures are reportedly good to excellent in >80% patients. Urgent reduction of the hip joint followed by anatomical reduction of the fracture and stable fixation of the fracture and osteotomy leads to predictably good results. Notable complications include heterotopic ossification, which has been reported in up to 60% patients, as well as osteonecrosis of the femoral head (often related to the initial injury rather than the approach) and degenerative arthritis of the hip joint. The Gibson interval may be utilized to preserve the gluteus maximus.Identify all of the posterior structures starting proximally from the posterior border of the gluteus medius, and continuing to the piriformis, triceps coxae, quadratus femoris, and the vastus lateralis.Aim for a thickness of 1 to 1.5 cm when performing the osteotomy; an osteotomy that is either too thick or too thin can negatively affect outcomes. The osteotomy should begin just anterior to the posterior fibers of the gluteus medius to ensure that the osteotomy is anterior to the piriformis tendon. It should exit distally to the vastus lateralis origin.Carefully elevate the posterior margin of the gluteus minimis from the capsule to avoid the tethering effect during anterior translation of the osteotomized fragment.Capsular tears during the initial dislocation are common and should be incorporated into the anterior capsulotomy.Repair of large posterosuperior labral tears may improve outcomes.Fixation of the fracture can be performed with mini-fragment screws or headless screws. Non-fixable small fragments can be excised.The osteotomy should be reduced and fixed in a stable manner to prevent trochanteric nonunion and preserve abductor function.

Management of nontraumatic osteonecrosis of the femoral head using impaction bone grafting via a light bulb window through a safe surgical dislocation approach

Purpose The aim was to appreciate the clinical and radiological results of impacted bone graft via bone window on the head-neck junction for treatment of nontraumatic avascular necrosis of femoral head through a safe surgical dislocation approach. Patients and methods A total of 33 hips in 26 patients were managed with femoral head osteonecrosis by impaction of autogenous iliac bone graft via bone window on the head-neck junction (light bulb) through a safe surgical dislocation approach. There were eight females and 18 males, with a mean age of 29.06 years (ranging from 14 to 46 years) with stage II and III avascular necrosis of the femoral head according to Association Research Circulation Osseous (ARCO). The results were studied based on variations in the Harris hip score and progress in radiographic stages. Results These 26 patients were followed up from 24 to 48 months (mean: 33.9 months). The mean Harris hip score was 82.78 (range from 66 to 95) after last follow-up when compared with 60.45 (range from 41 to 85) preoperatively. The clinical success for ARCO stage II was 75% (100% in stage IIA, 83.3% in stage IIB, and 50% in stage IIC) and for ARCO stage III was 43.5% (70% in stage IIIA, 60% in stage IIIB, and 0% in stage IIIC), whereas the overall radiographic progression was found in 15 of 33 hips (45.4%), where nine of them (27.3%) progressed to radiographic failure (femoral head collapse) and required total hip arthroplasty. Conclusions Impaction of autogenous bone graft through a safe surgical dislocation via a bone window creates a mechanical and biological condition for graft incorporation, and therefore, it may be the treatment of choice in nontraumatic osteonecrosis of the femoral head at the precollapse stage (stage II and early III), especially with a small-sized lesion, with a better outcome in idiopathic type.

Femoral Head Fracture without Dislocation of Hip in a Young Adult: A Case Report.

Introduction:Femoral head fractures are a rare pathology most often arising with high-energy traumas and associated with hip dislocations, which gravely compromise the ultimate functional outcome of the hip. Femoral head fractures without dislocation or subluxation are extremely rare injuries.Case Report:A 23-year-old male who sustained a high-energy trauma due to road traffic accident. He presented to ER with fracture of shaft femur, multi-ligament injury at the ipsilateral knee, fracture lower pole patella, ipsilateral fracture talus, and calcaneus along with comminuted fracture femoral head. He was managed by open reduction and internal fixation of the femoral head by safe surgical dislocation of the hip joint. Such injuries have been described rarely in the literature until now. The purpose of this report is to highlight the extreme rarity, possible mechanism involved, surgical management, and functional outcomes of such injuries.Conclusion:Femoral head fracture without dislocation is a very rare entity, early diagnosis, especially in high-energy trauma scenarios to prevent the neglect and delay in the treatment which is the paramount importance of an excellent result in young patients.

Le vie chirurgiche conservative: anca

The most common conservative approaches to the hip joint are the anterior, the Ganz safe surgical dislocation and the medial approach. The anatomy of these approaches is described in detail in this review. Each approach is also evaluated considering the surgical conservative indications, technique, and complications.

Safe Surgical Dislocation Approach for Open Reduction Internal Fixation of Femoral Head Fractures

Safe Surgical Dislocation Approach for Open Reduction Internal Fixation of Femoral Head Fractures