Intermediate-Term Experience of Pipkin Fracture-Dislocations of the Hip

Abstract

The purpose of this study was to review our intermediate-term experience with posterior fracture-dislocations of the hip. We evaluated the accuracy of the Pipkin and Brumback classification schemes as predictors of outcome, assessed the importance of certain treatment variables, and determined the complication rates of this injury in a group of 33 patients followed for an average of 49 months. The overall results were 67% good, 18% fair, and 15% poor, with no excellent results. The Pipkin classification scheme was a useful predictor of outcome because patients with less severe Pipkin 1 or 2 injuries had statistically significant better outcomes than did those who sustained Pipkin 3 or 4 injuries (p < 0.02). Due to a large number of subgroups, we could not demonstrate the usefulness of the Brumback classification system as a predictor of outcome. There were no statistically significant differences in outcome or complication rates when comparing time with hip reduction, definitive operative intervention, or anatomic operative approach to injury. Our study represents the second largest report on posterior dislocation of the hip associated with femoral head fracture. Although outcome of the patients in our series is not outstanding, the 67% good results represent a significant improvement over all previous reports with large numbers of patients. We demonstrate significant improvement in prognosis when treatment goals for these injuries include anatomic reduction, restoration of hip joint stability, and removal of all interposed bone fragments.

Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial

“…Anatomical study [7] showed that the main source of femoral-head vascular supply is the medial femoral circumflex artery, particularly its deep branch. Studies [11,16,17] showed that there is a significant decrease in operative time, estimated blood loss and improved visualisation with the anterior approach. The drawback in patients treated with an anterior approach was the development of more functionally significant heterotopic ossification, and prophylaxis with indomethacin or low-dose radiation should be considered to minimise heterotopic ossification.…”

“…Posttraumatic changes, such as heterotopic ossification, avascular necrosis of the femoral head and osteoarthritis may lead to a restriction in hip function and permanent disability, even in young patients. The choice treatment for Pipkin type 1 fractures remains controversial [10,11,14,17]. The absence of a validated outcome instrument has contributed to the lack of absolute recommendations and indications for the most appropriate treatment of femoralhead fractures associated with hip dislocations [16].…”

Fractures of the femoral head: what are the reasons for poor outcome?

“…3). The average age at the time of injury was 28 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) years. Most of the fractures were due to traffic accident; only one patient sustained injury from a motor vehicle accident.…”

“…However, good or excellent results are achieved in only 50% of cases after excision of the fragments. [8,9,[11][12][13][22][23][24][25][26][27] Over the past decades, rates of excellent or good results of 40-70% have been published in the literature. [8,[22][23][24][28][29][30][31] Our rate of excellent and good results was 50%, which was similar to the literature.…”

“…We used 2 mm countersunk titanium minifragment screws for the fixation in our patients without any problem. Some authors [23,34] advocated titanium or Herbert screws for MRI compatibility. Biodegradable screws have also been used successfully.…”