PubMed^® Literature Review

The case at hand involves a Pipkin type 1 femoral head fracture managed through operative treatment (1). Surgical management of such fractures has witnessed advancements in recent years, and controversies regarding surgical technique and approach have arisen.

The Pipkin classification system, widely utilized for femoral head fractures, differentiates the injuries based on fracture location and the presence of accompanying fractures (4,6). A critical aspect of managing these fractures is the timely reduction of the hip joint, ideally within 6 hours, to improve clinical outcomes and avoid irreversible complications (14). The choice of treatment hinges on the fracture type, with surgical intervention typically reserved for major fragment displacements exceeding 2 mm (20).

Surgical hip dislocation by the Ganz technique has been employed to treat posterior hip dislocations associated with femoral head fractures, as this method allows for optimal visualization of the joint and improves safety, functional, and radiological outcomes (8,14). However, trochanteric flip osteotomy (TFO) combined with surgical hip dislocation has also demonstrated promising results in terms of functional outcomes, avascular necrosis (AVN) rates, and fracture healing (12,18).

The management of high BMI patients with Pipkin type IV femoral head fractures has been performed through arthroscopy-assisted surgery, which mitigates the need for extending surgical incisions for improved visualization (3). Arthroscopic-assisted percutaneous fixation is another technique that may minimize surgical morbidity and expedite recovery (15).

Osteosynthesis, another treatment option, has been performed in various cases with different types of fixation materials such as resorbable screws, 3.5-4 mm screws, 6.5 mm screws, and K-wires (16). Factors influencing the outcome of osteosynthesis after closed reduction of femoral neck fractures in young adult patients have been examined in a retrospective study (13). Furthermore, osteosynthesis of femoral head fractures with hip dislocations has been reported in the literature, with the frequency of such fractures estimated at approximately two cases per million per year (17).

In conclusion, while surgical hip dislocation with the Ganz technique and TFO has demonstrated favorable outcomes, arthroscopy-assisted surgery for high BMI patients, and arthroscopic-assisted percutaneous fixation as a means of optimizing femoral head fracture treatment, are emerging alternatives (8,14,15). A comprehensive understanding of these techniques and their potential benefits and drawbacks is necessary for choosing the most appropriate treatment strategy for patients with femoral head fractures.