Is There a Role for Hip Arthroscopy in Patients With Femoral Head Fractures?

NCT ID: NCT06491420

Last Updated: 2024-07-09

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 5 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-01-01
• Study Completion Date: 2024-12-01

Brief Summary

Femoral head fractures, often caused by high-energy trauma, pose significant challenges due to complications like avascular necrosis, post-traumatic osteoarthritis, and sciatic nerve damage. While traditionally treated with open reduction and internal fixation (ORIF) or total hip replacement (THR), hip arthroscopy has emerged as a minimally invasive alternative that reduces surgical trauma, offers direct fracture visualization and manipulation, and may result in shorter recovery times and fewer complications.

Detailed Description

Femoral head fractures are uncommon but serious injuries often happen because of high-energy trauma, such as traffic accidents or falls from heights. These fractures can result in complications such as avascular necrosis (if associated with hip dislocations), post-traumatic osteoarthritis, heterotopic ossification, and sciatic nerve damage. The management of femoral head fractures is challenging and depends on several variables, such as the fracture pattern, the degree of displacement, the existence of associated injuries, and the patient's age and physical activity.

Traditionally, open reduction and internal fixation (ORIF) or total hip replacement (THR) have been the treatment of femoral head fractures, depending on the extent of the damage and the patient's expectations. However, these procedures have some drawbacks, such as increased blood loss, infection risk, surgical trauma, and implant-related complications. Furthermore, THR might not be appropriate for young, active patients who wish to maintain their natural hip joint, whereas ORIF might not be able to adequately reduce and fixate the fracture fragments, particularly in situations of comminution or impaction.

Nevertheless, hip arthroscopy has surfaced as a minimally invasive alternative for the treatment of selected femoral head fractures. Arthroscopy could be useful in femoral head fractures as it minimizes surgical aggression, in contrast to surgical hip dislocation applied in ORIF, allowing for direct control of fracture reduction, minimizing surgical morbidity, and optimizing early recovery. Hip arthroscopy allows for direct visualization and manipulation of the fracture fragments, as well as the removal of loose bodies and debris from the joint. Hip arthroscopy can also be combined with percutaneous fixation techniques to stabilize the fracture and restore joint congruence. When compared to open surgery, hip arthroscopy may offer several benefits, including shorter recovery times, less discomfort, less blood loss, and better cosmetic results. Arthroscopic-assisted percutaneous fixation has been reported as an effective treatment in selected cases of femoral head fractures.

Conditions

Femur Head Fracture; Arthroscopy

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Patients with pipin 1 fractures fixed with arthroscopy

Accurate portal placement was essential for optimal visualization and safe access to the hip joint.

• The anterolateral, anterior, and distal lateral accessory portals were utilized for arthroscopic labral repair.
• The anterolateral portal was placed approximately 1-2 cm superior to the tip of the greater trochanter and 1-2 cm anterior, at an angle of 15° to 20° relative to the floor.
• The anterior portal was established for visualization of the posterior-superior capsule, posterior-superior labrum, posterior recess, femoral head, ligamentum teres, and other structures.
• The distal lateral accessory portal was placed after traction was released and the operative knee was flexed to 45°.

After reducing the fracture under arthroscopic guidance, a guidewire fixed the fracture a cannulated screw was passed over the wire to fix the fracture.

Group Type: EXPERIMENTAL

fixation with arthroscopy

Intervention Type: OTHER

the pipkin fracture is fixed with the help of arthroscopy and percutaneous methods.

Interventions

fixation with arthroscopy

the pipkin fracture is fixed with the help of arthroscopy and percutaneous methods.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Patients with pipkin 1 fractures

Exclusion Criteria

• any associated pelvic fractures
• severe medical conditions that prevent the patient from undergoing surgery
• delayed presentation after 2 weeks from initial fracture date

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 55 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Kasr El Aini Hospital

OTHER

Sponsor Role: lead

Responsible Party

Ahmed Omar Sabry

Dr.

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Kasr Al Ainy-Cairo University- Faculty of Medicine

Cairo, Manial, Egypt

Site Status: RECRUITING

Countries

Egypt

Central Contacts

Ahmed Hazem, MD

Role: CONTACT

azeem@kasralainy.edu.eg

+20 122 330 3789

Facility Contacts

Ahmed O Sabry, MBBS

Role: primary

sniperrifle22@gmail.com

+201117632926

Other Identifiers

MD-038-2024

Identifier Type: -

Identifier Source: org_study_id