Pipkin type III femoral head fracture–dislocation combined with complicated acetabular fracture

Abstract

Rationale:Pipkin III fracture, which is characterized by high risk of avascular necrosis of the femoral head, is extremely rare. It is more difficult to treat and has a worse prognosis when accompanied with severe acetabular fractures. Few studies show that both Pipkin type III femoral head fracture–dislocation and complicated acetabular fracture presented in one patient.Patient concerns:A 34-year-old male suffered a terrible traffic accident with a serious damage to the left side when he was sitting in the car's cockpit. Pelvic radiograph and 3-dimensional reconstruction of computed tomography revealed characteristics of fractures before the emergency operation.Diagnosis:Pipkin III fractures combined with complicated acetabular fracture.Interventions:Firstly, we used combined anterior and posterior approach for treatment to fix the femoral head fractures. Then, we completed anatomical reduction of fractures with countersunk head screw, hollow screw, and reconstruction plate.Outcomes:At the 12-months follow-up, the patient could walk freely and perform activities of daily living without necrosis of femoral head and heterotopic ossification.Lessons:Although there are serious complications in Pipkin III fractures combined with complicated acetabular fracture, early surgical treatment with appropriate approach and fixation could get satisfactory results.

Functional Outcome of Pipkin Type III Fracture Managed by Osteosynthesis through Trochanteric Flip Osteotomy in a Young Patient after 5 Years Follow-Up – A Case Report and Literature Review

“…Almost all previous studies showed that these fractures are usually due to high-energy trauma, as in this study [ 6 , 8 , 9 ]. Usually, type III Pipkin’s fractures occurred when the hip is in <60 degrees of flexion, although the patient was not sure about the position of the limb in our study [ 7 ].…”

“…Zhao et al [ 6 ] reported a case of type III Pipkin’s fracture with an acetabular fracture in a 34-year male. This patient had a satisfactory outcome after osteosynthesis through anterior and posterior approach after 1 year of follow-up.…”

“…The reasons for writing this case report are to explain the importance of preserving the native hip joint in young age which would help in decision-making in such challenging fractures as there is no universally accepted recommendation available due to rarity of these injuries and lack of adequate literature [ 2 , 6 , 7 , 8 , 9 ].…”

Management of a Pipkin Type III Femoral Head Fracture Via Ganz Approach with a Cannulated Lag Screw &amp; Herbert Screw

“…However, in the presence of avascular necrosis of the femoral head, associated complications in using screw xation can only be avoided and reduced by improving the surgical technique applied. Current surgical approaches for femoral head fractures vary and include the medial approach (Ludloff approach) and the anterior approach (Smith Petersen approach), the antero-medial fenestration approach, the Watson-Jones Approach, the lateral approach and the Kocher-Langenbeck approach [13][14][15][16]. Despite these options, it remains a challenge to easily expose the femoral head and complete the reduction and xation under direct vision.…”

Femoral head fracture in an adult patient with isolated posterior labrum avulsion recognized through the ‘fleck’ sign: technical tips

“…The incidence of this injury increased in these recent years due to improved resuscitation, which led to increased survival of the severely injured patients [3]. As poor functional outcomes were associated with conservative treatment of femoral head fractures, surgical treatment indications became wider [3, 7, 8]. Femoral head fractures are known to be frequently associated with femoral neck fractures, acetabular fractures, sciatic nerve neurapraxia and knee ligamentous lesions as per the mechanism of the initial injury [5, 9, 10].…”