This study evaluates the outcomes of 18 patients who underwent surgical dislocation of the hip using Ganz's technique to treat Pipkin fractures of the femoral head. Pipkin fractures are rare fractures that occur when the femoral head fractures as a result of a posterior hip dislocation. Traditional approaches provide limited exposure, while Ganz's technique allows 360 degree visualization through an anterior dislocation of the femoral head. The study found statistically significant improvements in functional scores at 1 year follow up, with no cases of avascular necrosis, demonstrating that Ganz's technique is an effective and safe method for treating these complex fractures.

1. Dr. Mohammed Ashraf - professor and head
Dr rahul thampi-assistant professor
Dr. E .K. Shanavas-associate professor
Dr sethu sivan-associate professor
Govt.T.D.Medical College Hospital,
Alleppey,kerala,india

5. FEMORAL HEAD EXPOSURE

7. INTRODUCTION
• Pipkin’s fractures—head of femur
fractures
• Rare constituting 5-15 %
• Associated with posterior dislocation of
hip
• Four types depending on severity

8.  Associated complications:- osteonecrosis ;
heterotopic ossification; osteoarthritis and
sciatic nerve injury
Giannoudis et al reviewed 29 articles
‘Management, complications and clinical results of femoral head fractures’;
Injury,2009 Dec;40(12);1245-51
Findings :
Avascular necrosis(11.9%), post-traumatic arthritis (20%) and HO
Giannoudis et al reviewed 29 articles
‘Management, complications and clinical results of femoral head
fractures’; Injury,2009 Dec;40(12);1245-51
Findings :
Avascular necrosis(11.9%), post-traumatic arthritis (20%) and HO
(16.8%)

9.  Oransky et al in ‘Fractures of the
femoral head: a long term follow-up
study’, showed that regardless of the
type of treatment, long term
consequences as avascular necrosis,
post traumatic arthritis and
heterotopic ossification may
complicate clinical outcome leading to
variable degree of disability
Musculoskelet Surg. 2012 Aug;96(2):95-9. doi: 10.1007/s12306-012-0182-7

10.  Traditionally, most common approaches –
1. Posterior:- Kocher –Langenbeck
2. Anterior:- Smith-Peterson
3. Antero-lateral:- Watson-Jones
Disadvantages
 Limited exposure of femoral head and
acetabulum.
 Anatomical reduction difficult
 Identification of associated injuries difficult

12. J Bone Joint Surg [Br] 2001;83-B:1119-1124.

14. OBJECTIVE
Our main objective was to assess the
functional outcome after employing the
Ganz’s technique for safe surgical
dislocation of hip for patients suffering
from Pipkin’s fractures

15. Safe surgical dislocation of hip (SSD)
 Anterior dislocation of femoral head using
‘trochanteric flip osteotomy’
 External rotator muscles not divided
 Medial circumflex femoral artery (MFCA)
 Protected by intact obturator externus
PRINCIPLES

16. ‘Anatomy of the medial femoral circumflex artery and its surgical
implications’. Gautier E, Ganz K, Krügel N, Gill T, Ganz R,JBJS 2000 Jul;82(5):679-83
The primary source for the blood supply of the head of the femur is the
deep branch of the medial femoral circumflex artery (MFCA).

17. SURGICAL TECHNIQUE

26. • 360 degree view
• Anatomic fixation
• Other injuries
• Reduced progression rate—post-
traumatic arthritis or AVN
• Labral injuries—50%
Missing –worse prognosis
ADVANTAGES OF
SSD

28. ‘Associated labral injuries and presence of cartilaginous
defects in the weight-bearing area may also be an
independent risk factor for a poor outcome in these
fractures.’

29. MATERIALS AND METHODS
 Study design:-A prospective study non-randomised
in nature
 Study setting:- A tertiary care trauma centre
 Study population:- Eighteen subjects--h/o RTA or
fall from height ; males (n=15) 83% and
females (n=3) 17%

30. MALE : FEMALE
MALES
FEMALES
Males:-15 Nos
Females:-3 Nos..

31. • Age of study subjects ranges from
28-45
• Mean age being 34.78
• Study started in October 2016
Followed up for three years with
average follow up of 1 ½ years

32. 0
2
4
6
8
10
12
14
16
18
Type 1 Type 11 Type 111 Type 1V

33. Functional outcome using -
1) Modified Merle d’ Aubigne scores and
2) Modified Harris’ Hip Score [MHHS]
Outcome
measurements

34. Modified Merle d’ Aubigne score Modified Harris’ Hip Score

35. RESULTS
 Fixation done for all eighteen patients
 Mean modified Merle d’Aubigne score
was 16.89 (14-18) at 1 year
 Mean modified Harris’ hip score was
95.5 at 1 year

36.  Wilcoxon signed ranks test
A non-parametric test
 p value < 0.001
 Hence statistically significant

37. DISCUSSION
 Pipkin’s fractures:-
4 types
 First description-
1869 -Birkett
 Classification –
1957
Garrett Pipkin

38.  All surgical dislocations done by senior
author
 Length of hospital stay :- 6 days (3–10
days)
 Followed up every three months
 Toe touch:- 8 weeks; full weight
bearing:- 3 months

39.  Pain gradually reduced to nil
 Mobility detected to be very good
 Flexion of hip > 90 degrees ; abduction > 30
deg
 All patients free from walking aids at last
follow-up with full weight bearing
 Limp detected in a single patient during
follow-up
A suspicious case of osteonecrosis

40. 0
6
12
18
Trochanteric
delayed union
Superficial wound
infection
Trochanteric
bursitis
Limp
No: of patients

45. CONCLUSION
 Technically challenging
 But assumes a great role in Pipkin’s
fractures
 Effective and safe methodology
 Allows a 360 degrees visualisation of
femoral head and acetabulum
 Helps treat other associated injuries
 Anatomic fixation

47. REFERENCES:-
 The Journal of Bone and Joint Surgery
 Injury
 Musculoskeletal Surgery
 Journal of Orthopaedic Trauma

49. Govt T.D Medical College
Hospital
FACULTY
Dr.Mohammed Ashraf
Dr.Salim M.P.
Dr.Georgekutty A.M.
Dr.P.Syam
Dr.Shanavas E.K.
Dr.Sethu S.
Dr.Alen Sigamani
Dr.Bindulal V.A.
Dr.Joseph Dickson Olivero
Dr.Manesh Stephen
Dr.Unnikrishnan J.
Dr.Mohammed Sameeh.S.
Dr.Thomas Koshy
Dr.Jyothis George
RESIDENTS
Dr.Manu Mohan
Dr.Shinas B.Salam
Dr.Siyad Ahammad P.P.
Dr.Muhammed Nasweef
Dr.Ahammed Shaheel
Dr.Rahul Thampi
Dr.Philipson J.Philip
Dr.Mahesh S.
Dr.Thomas George
Dr.Sujith P.S.
Dr.Sakkir P.
Dr.Sherindas P.
Dr.Mohammed Irshad