Table Of ContentFracture Management Joint by Joint
Series Editors: Filippo Castoldi · Davide Edoardo Bonasia
Lorenz Büchler
Marius J.B. Keel Editors
Fractures of
the Hip
Fracture Management Joint by Joint
Series editors
Filippo Castoldi
Department of Orthopaedics
CTO Hospital Turin
Torino
Italy
Davide Edoardo Bonasia
University of Torino
AO Ordine Mauriziano
Torino
Italy
This book series aims to provide orthopedic surgeons with up-to-date
practical guidance on the assessment, preoperative work-up, and surgical
management of intra-articular fractures involving different joints, including
the shoulder, knee, hip, elbow, ankle, and wrist. Complex articular fractures
are difficult to treat and sometimes require specific surgical skills appropriate
to the involved joint. In addition, arthroscopic-assisted fracture reduction is
increasing in popularity, but trauma surgeons are generally not trained in
arthroscopic techniques. For these reasons, articular fractures are often
referred by the trauma team to surgeons experienced in the management of
injuries to the joint in question. Therefore, across the world it is becoming
common for orthopedic surgeons to specialize in treating fractures of only
one joint. This series is designed to fill a gap in the literature by presenting the
shared experience of surgeons skilled in the use of arthroscopic and open
techniques on individual joints.
More information about this series at http://www.springer.com/series/13619
Lorenz Büchler • Marius J.B. Keel
Editors
Fractures of the Hip
Editors
Lorenz Büchler Marius J.B. Keel
Department of Orthopaedic Surgery Trauma Center Hirslanden
Kantonsspital Aarau Clinic Hirslanden
Aarau Zürich
Switzerland Switzerland
ISSN 2364-3250 ISSN 2364-3269 (electronic)
Fracture Management Joint by Joint
ISBN 978-3-030-18837-5 ISBN 978-3-030-18838-2 (eBook)
https://doi.org/10.1007/978-3-030-18838-2
© Springer Nature Switzerland AG 2019
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Foreword
This book series aims to provide orthopaedic surgeons with up-to-date practi-
cal guidance on the assessment, preoperative work-up and surgical manage-
ment of intra-articular fractures involving different joints. Complex articular
fractures are difficult to treat and sometimes require specific surgical skills
appropriate to the involved joint. In addition, arthroscopic-assisted fracture
reduction is increasing in popularity, but trauma surgeons are generally not
trained in arthroscopic techniques. For these reasons, articular fractures are
often referred by the trauma team to surgeons experienced in the management
of injuries to the joint in question. Therefore, across the world it is becoming
common for orthopaedic surgeons to specialize in treating fractures of only
one joint. This series is designed to fill a gap in the literature by presenting the
shared experience of surgeons skilled in the use of arthroscopic and open
techniques on individual joints.
In this specific book, Dr. Büchler and Dr. Keel, world renowned experts in
this field, developed a comprehensive table of contents regarding hip frac-
tures. Surgical anatomy and relevant radiology are described together with
different surgical approaches, including those that many surgeons are not
very familiar with. Then, acetabulum and proximal femur fracture manage-
ment is described in detail including conservative and surgical treatments.
The management (open and arthroscopic) of some common complications
(malunion, nonunion, loose bodies, etc.) is included as well. Experts from all
over the world were invited to participate in this project. The result is a practi-
cal reference guide for the hip surgeon, trauma surgeons and orthopaedic
resident approaching simple and complex fractures around the hip.
Torino, Italy Filippo Castoldi
Torino, Italy Davide Edoardo Bonasia
v
Preface
The series “Fracture Management Joint by Joint”, to which this volume
belongs, has introduced a new concept of up-to-date literature emphasizing
the importance to assess articular fractures in the context of the entire ana-
tomical region. Thus, the book is intended to be useful to the specialized
orthopaedic surgeon and general trauma surgeon alike.
A wide variety of approaches and surgical techniques are used to treat hip
fractures, and the selection of the best therapy is challenging. The purpose of
this book is to support the reader towards a broad understanding of the trau-
matized hip, including anatomy, biomechanics, diagnosis and surgical treat-
ment. As a result, the surgeon should be confident to choose the appropriate
treatment for a specific fracture in an individual patient, may this be conser-
vative, by osteosynthesis or through total hip arthroplasty.
We have assembled a group of renowned trauma surgeons from around the
world to present a comprehensive, up-to-date overview over their respective
field of expertise. The book is divided into three sections: Principles, includ-
ing anatomy, biomechanics, radiology and initial management, chapters on
surgical approaches and chapters on specific fracture types, pathological frac-
tures and complications.
It has been a tremendous pleasure to interact with such an excellent fac-
ulty, and we thank the authors for having dedicated their time and expertise.
We have learned a lot ourselves. Also, we would like to thank the editorial
staff at Springer. Without their great assistance and support, this project
would not have been possible.
We hope that the entire series, and this book in particular, will serve as a
valuable tool in the reader’s clinical practice.
Bern, Switzerland Lorenz Büchler
Zürich, Switzerland Marius J.B. Keel
vii
Contents
1 Anatomy of the Hip Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Michael Wyatt, Carl Freeman, and Martin Beck
2 Radiology of the Hip Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Florian Schmaranzer, Till D. Lerch,
Inga A. S. Todorski, Moritz Tannast,
and Simon Steppacher
3 Initial Management of Hip Fractures Prior
to Surgical Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Mark Haimes and Michael Blankstein
4 Ilio-Inguinal Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Lorenz Büchler and Helen Anwander
5 Anterior Approaches to the Acetabulum . . . . . . . . . . . . . . . . . . . 53
Claude H. Sagi
6 The Pararectus Approach to the Acetabulum . . . . . . . . . . . . . . . 69
Johannes D. Bastian and Marius J.B. Keel
7 Lateral Approach to the Pelvis and Hip . . . . . . . . . . . . . . . . . . . . 77
Joseph M. Schwab, Chad Beck, and Klaus A. Siebenrock
8 Extended Iliofemoral and Combined Approaches . . . . . . . . . . . . 89
Marius J.B. Keel
9 Traumatic Hip Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Mark Rickman and Lorenz Büchler
10 Acetabular Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Ippokratis Pountos and Peter V. Giannoudis
11 Pipkin Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Benedikt J. Braun, Jörg H. Holstein, and Tim Pohlemann
12 Femoral Neck Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Govind S. Chauhan, Mehool Acharya,
and Tim J. S. Chesser
13 Pathologic Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Frank M. Klenke, Attila Kollár, and Christophe Kurze
ix
x Contents
14 Acetabular and Femoral Neck Fracture Nonunion
and Malunion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Robert C. Jacobs, Craig S. Bartlett, and Michael Blankstein
15 The Use of Hip Arthroscopy in Trauma of the Hip . . . . . . . . . . . 189
Alessandro Aprato, Federico Bertolo, Alessandro Bistolfi,
Luigi Sabatini, and Alessandro Massè
1
Anatomy of the Hip Joint
Michael Wyatt, Carl Freeman, and Martin Beck
Abstract to not only understand hip pathology but also to
The normal hip is often described as a synovial intervene safely with procedures such as surgi-
ball and socket joint but this hardly does it jus- cal hip dislocations. In this chapter we will
tice. The hip represents a remarkable coexis- explore both acetabulum and proximal femur
tence of stability married to versatility in from their development to final morphology.
motion. Furthermore this biomechanical phe- We shall delve into what is known about the
nomenon is built to sustain the demands of a labrum and other articular structures. Finally
lifetime and today such demands are ever we shall scrutinize the complex blood supply to
increasing. In broad terms the bony anatomy the hip for this is paramount to the prognosis of
with concave socket articulating with the femo- non-a rthroplasty treatment of intra-articular hip
ral head creates an incredibly stable joint chal- fractures and preventing complications.
lenged only in the most part by high-e nergy
trauma. Its complex intra-articular structures Keywords
and lubrication system create a mobile and Hip · Anatomy · Embryology · Surface
durable couple, the secrets of which have not anatomy · Blood supply
yet fully been elucidated. The intricate arterial
anastomoses supplying the joint have only been
revealed in recent years. The application of this
anatomical knowledge has permitted surgeons 1.1 Landmarks of the Hip Joint
The most readily identifiable landmarks for the
hip and acetabulum are the greater trochanter and
M. Wyatt (*)
the anterior superior iliac spine (ASIS). The ASIS
Department of Trauma and Orthopaedics, MidCentral
District Health Board, Palmerston North Hospital and lies superiorly and just laterally to the acetabu-
Massey University, Palmerston North, Manawatu, lum in the coronal plane and indicates the loca-
New Zealand
tion of the anterior column, the anterior wall, and
e-mail: [email protected]
the iliac crest. The lateral femoral cutaneous
C. Freeman
nerve lies between two and four centimeters
Jacksonville Orthopaedic Institute,
medial from the ASIS [1]. The anterior inferior
Jacksonville, FL, USA
iliac spine (AIIS) lies directly anterior and supe-
M. Beck
rior to the acetabulum (Fig. 1.1). The iliopectin-
Clinic for Orthopaedic and Trauma Surgery, Luzerner
Kantonsspital, Luzern, Switzerland eal eminence, which develops from the pubic
© Springer Nature Switzerland AG 2019 1
L. Büchler, M. J.B. Keel (eds.), Fractures of the Hip, Fracture Management Joint by Joint,
https://doi.org/10.1007/978-3-030-18838-2_1
