Management of Pipkin Fractures Using a Safe Surgical Hip Dislocation (original) (raw)
Related papers
Treatment Options in Pipkin Fracture-Dislocation of the Femoral Head: Cases Review
Jurnalul de Chirurgie, 2016
Background: Fractures of the femoral head associated with a hip dislocation are relatively rare and often associated with a poor functional outcome. Materials and methods: In the past two years we had nine cases of femoral head Pipkin fracture-dislocations type I, II and IV. Medical data and radiographs, including computed tomography of the patients were reviewed for analysis. All patients were followed postoperatively for a period of minimum 22 months. Functional outcome was evaluated with the Merle d'Aubigne-Postel score. Results: Of the fractures, four of them were classified as type I Pipkin, of which one was an open type 1 Gustilo-Anderson fracture, two were classified as type II Pipkin, and three were classified as type IV Pipkin. The time from injury to successful closed reduction was 6.7 hours (range 4.5-10 hours). Three type I Pipkin fracture-dislocations were treated by conservative means (no surgery) and one case required excision of intra-articular free bodies. In type II Pipkin fracture-dislocations, open reduction and internal fixation (ORIF) was performed in one case and hemiarthroplasty in the other. In type IV Pipkin lesions, we performed open reduction and internal fixation of the acetabular fracture through posterior Kocher-Langenbeck approach and excision of femoral head intra-articular free bodies The overall outcome was excellent in four cases and good in five cases. Throughout the follow-up period, there was no case of avascular necrosis (AVN) recorded. Heterotopic ossifications (HO) were observed in one case of type I Pipkin, two cases of type II Pipkin and one case of type IV Pipkin fractures. Conclusion: Treatment aim should always be the anatomic reduction of the fragments with minimal soft tissue injury. Sometimes closed reduction is enough, but in the presence of large fragments, the fracture-dislocation is better treated by ORIF. We should not forget that half of these patients will have good outcomes no matter the treatment strategy; this result depends on the general health of the patient, the severity of the injury, associated injuries, associated cartilage injury, and timing of admission to the hospital.
Treatment of Pipkin Type II Fracture Caused by Dislocation of Hip Joint
2016
The patient at the age of 34 and 150kg of body weight suffered left hip posterior dislocation with femoral head fracture in car crash accident. The patient had been admitted to hospital after midnight. The mechanism of injury goes as follows: axial force and flexion in the hip caused by impact of the car. The left leg clinically observed is in painful extension, with minimal movement, strong pain and shortened leg. X-rays shows posterior hip joint dislocation and fracture of the femoral head. Closed reduction under anesthesia was unsuccessful. 3D CT reconstruction that had been taken before proceeding to open procedure shows posterior hip dislocation with femoral head fracture above fovea involving weight bearing portionPipkin type II fracture dislocation.
A short term review of Pipkin fractures type I treated surgically
Indian Journal of Orthopaedics Surgery, 2020
Background: head of femur fractures along with a hip dislocation is a rare & most probably has a poor outcome. Materials and Methods: In the taken period of 1 yr, we came across nearly twenty cases of Pipkin fracture type I. Through Medical and radiographs evaluation was done and recorded. The followup was done for these selected patients for a period of 12 months. Merle d'Aubigne-Postel score was the score used and recorded the functional outcome of each patient in the study and analized. Results: the cases selected were Pipkin type 1 fracture with dislocation. The time interval between the incident and the successful reduction in the hospital was about 5.6 hrs avg among all the cases. The outcome of the surgically treated cases 8 of them out of 10 showed excellent results clinically and functionally. No complications like AVN and HO or neuro vascular injury was noted in any cases. In our study surgically treated cases showed better results than treated conservatively Conclusion: Anatomic reduction is must with marginal soft tissue injury. This type I Pipkin fracture better treat surgically than conservative.
Hip subluxation associated with Pipkin II fracture: an injury to look for before reduction
2009
Fractures of the femoral head are rare. They usually occur in association with a posterior hip dislocation secondary to a high-energy trauma (motor vehicle accident). We report a case of Pipkin II fracture associated with an irreducible hip subluxation. Clinical signs are poor unlike in posterior hip subluxation. CT scan is important to evaluate the traumatism. The Hardinge approach is relevant in this context of irreducible hip subluxation. The clinical, diagnostic, and therapeutic particularities of this lesion type are discussed.
Pipkin type IV femoral head fractures: a case series and review of literature
European Journal of Orthopaedic Surgery & Traumatology, 2020
Introduction Femoral head fractures with associated acetabular fractures are uncommon injuries usually resulting from high-energy mechanisms such as motor vehicle collisions. Outcomes of Pipkin type IV fractures have been historically poor, with high rates of osteonecrosis, post-traumatic arthritis, and heterotopic ossification. The objective of this study was to define the outcomes of operatively treated Pipkin type IV fractures In addition, we reviewed the available literature of this uncommon injury pattern. Methods A retrospective chart review at a single level 1 trauma center from 2007 to 2016 identified 10 patients with Pipkin IV femoral head fractures. Demographic information, fracture type, associated injuries, operative details, and complications were evaluated. Clinical and radiological outcomes were assessed at latest follow-up including conversion to total hip arthroplasty. Results Six of the seven patients were treated with open reduction and internal fixation of the femoral head fracture and acetabular fracture through a Kocher-Langenbeck approach aided by a trochanteric flip and one had fragment excision. Six patients (87.5%) developed post-traumatic arthritis. Four (57.1%) later underwent conversion to total hip arthroplasty (THA) a mean of 20.5 months after index procedure. Conclusion Our study shows a rate of osteonecrosis and osteoarthritis that is even higher than the previously reported studies. The former may relate to longer-term follow-up and the latter possibly due to associated comminuted posterior wall fracture.
Journal of surgical case reports, 2015
A hip fracture dislocation with contralateral femur fracture is a rare combination. We report a case of neglected posterior dislocation of hip with Pipkins-II femoral head and medial condylar fractures associated with a contralateral femoral shaft fracture. Right hip joint was approached via the Kocher-Langenbeck, following reduction, femoral head fragments were fixed with two 4-mm cannulated cancellous screws with open reduction internal fixation plating of ipsilateral femoral condylar fracture and closed reduction internal fixation nailing of left femur in the same sitting. Immediate postoperative X-rays were satisfactory. Postoperative period was uneventful. Over 7-year follow-up, patient is successfully performing his duties with X-rays bearing no signs of avascular necrosis (AVN) or hip arthritis. Thus, complex femoral fractures require a multidisciplinary approach for successful treatment. Early congruous reduction, anatomical fixation and early rehabilitation help in reducing...
Stress fracture of the femoral neck after Pipkin type IV hip injury
Vojnosanitetski pregled, 2017
Introduction. Hip fractures/dislocations of Pipkin type IV are rare, often accompanied by complications and poor outcome. We describe a complication in the form of a stress fracture of the femoral neck (SFOFN) after the Pipkin type IV fracture ? dislocation of the hip. Case report. A healthy male, TAXI driver, aged 60, was injured in a traffic accident and admitted as a polytraumatised patient with the Pipkin type IV hip injury. Open reduction and internal fixation had been done. Completely recovered, 9 months after the injury during a walk he felt pain in the operated hip and was unable to bear weight. We noted a dislocated subcapital SFOFN which did not form on the site of the previous osteosynthesis. Conclusion. Pipkin type IV hip injury as a result of polytrauma, unstable joint and osteosynthesis, inadequate weight bearning and disposal of physical therapy, increases the risk of complications such as avascular necrosis, or as in our case, a stress fracture (caused by weight over...
Irreducible Pipkin II femoral head fractures: Is transgluteal approach the best strategy?
2010
Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment. Level of evidence: Level IV retrospective historical study.