Digastric trochanteric flip osteotomy: Functional outcome of fixation of acetabulum fractures and femoral head fractures

Abstract

Introduction: One of the most challenging fractures to manage in orthopaedics are the acetabulum and femoral head fractures. With a complex fracture pattern, anatomic reduction with safety of the neurovascular structures is needed. The study aims at assessing the functional outcome of fixation of acetabulum and femoral head fractures with the use of digastric trochanteric flip osteotomy. Material and Methods: The study included 20 patients which was carried out at our institute from January 2019 to December 2023. There were 14 patients with acetabulum fracture and 6 patients with femoral head fracture. They were investigated with radiographs and computed tomography (CT) scans and classified using the Letournel and Judet classification for acetabulum fractures and Pipkin classification for femoral head fractures. Surgical procedure included fixation through modified Kocher Langenbeck (KL) approach with digastric trochanteric flip osteotomy for acetabulum fractures and safe surgical dislocation of hip with digastric trochanteric flip osteotomy for femoral head fractures. Matta’s radiological criteria was used to assess quality of reduction and modified Harris Hip score was calculated 1 year post surgery to assess their functional status. Results: Modified Harris Hip score calculated at 1 year post surgery showed excellent to good results in 17 patients. Reduction was anatomic in 17 patients, imperfect in 2 and poor in 1 patient according to Matta’s criteria. One patient developed avascular necrosis and had foot drop. No patient had infection, abductor weakness, heterotopic ossification, deep vein thrombosis, non-union at the site of osteotomy. Conclusion: Digastric trochanteric flip osteotomy provides improved exposure for anatomical fixation of acetabulum fractures and allows for safe surgical dislocation of the hip for fixation of femoral head fracture with little risk of damaging the vascularity of the femoral head.