Mid- and long-term clinical effects of trochanteric flip osteotomy for treatment of Pipkin I and II femoral head fractures.

OBJECTIVE To investigate the mid- and long-term clinical results of trochanteric flip osteotomy for treating Pipkin type I and II femoral head fractures. METHODS We retrospectively reviewed twenty-three patients (aged 23-72 years with a mean of 44.1 years, including 15 male and 8 female patients) with femoral head fractures and posterior hip dislocation. The fracture was classified according to Pipkin classification based radiographic findings, and 9 patients were found to have type I and 14 had type II fractures. Trochanteric flip osteotomy was performed in all patients for surgical open reduction and internal fixation of the fractures. The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale and Merle d' Aubigne-Postel score. RESULTS One patient with follow-up period less than 12 months was excluded from analysis. Of the 22 patients (95.7%) followed up for more than 12 months (mean 23.5 months), the average Merle d' Aubigne Postel score was 13.77 at the final follow-up. According to the Thompson-Epstein criteria, 8 (36.4%) patients had excellent, 9 (40.9%) had good, 3 (13.6%) had fair, and two (9.1%) had poor outcomes; the total rate of excellent and good outcomes was 77.3% in these 22 patients. None of the patients developed habitual dislocation of the femoral head after the operation. Heterotopic ossification occurred in 2 patients. Partial neurapraxia of the sciatic nerve occurred in one patient and recovered completely within 6 months. Three patients developed post-traumatic arthritis, and one of them had avascular necrosis of the femoral head one year after surgery and received subsequently total hip arthroplasty. CONCLUSION The follow-up data demonstrate that trochanteric flip osteotomy is an effective and reliable option for treating Pipkin type I and type II femoral head fractures.