THE CLASSIC: Description of a Dislocation of the Head of the Femur, Complicated With its Fracture; With Remarks by

Birkett, John

doi:10.1097/blo.0b013e31803df21f

Cited by 6 publications

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“…Posterior dislocation of hip joint with femoral head fracture is not common. [ 1 ] Epstein–Thomas type V fracture dislocation was divided into 4 subtypes by Pipkin, [ 2 , 4 ] of which type III lesions are relative rare, caused by severe high energy injuries and characterized by fractures of the femoral head and neck. [ 2 , 5 ] It is difficult to make surgical operation for type III fractures which often have poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

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

Zhao

Jiang

et al. 2017

Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

“…Fracture of the femoral head was first reported by Birkett in 1869. [ 1 ] Pipkin divided Epstein–Thomas type V fracture dislocation into 4 subtypes according to the type of fracture in 1957. [ 2 ] According to the classification, only Pipkin type III injuries contain fracture of femoral neck.…”

Section: Introductionmentioning

confidence: 99%

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

Zhao

Jiang

et al. 2017

Medicine

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“…Approximately six to 16% of posterior hip dislocations have been noted to be associated with a femoral head fracture. 4 Degree of fragmentation, location and size of the femoral head fragment are related to the position of the hip at the time of the trauma. 3 Pipkin classification of these fractures in four types according to fracture morphology and relation with femoral neck or acetabular fractures: fracture caudal to the fovea capitis (type I), fracture cephalad to the fovea capitis involving the weight-bearing portion of the femoral head (type II), fracture inferior to the fovea centralis (type I or II) plus femoral neck fracture (type III) and femoral fracture associated to acetabular fracture (type IV).…”

Section: Introductionmentioning

confidence: 99%

Functional outcome of type 4 Pipkin classification of femoral head fracture operated by open reduction internal fixation by ganz safe surgical dislocation approach management: a case report

Daruwala¹,

Patil²,

Kulkarni³

et al. 2023

Int J Res Orthop

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Fracture of the femoral head is a severe, relatively uncommon injury; typically, it may have associated with traumatic posterior dislocation of the hip joint with or without acetabulum fracture. The Pipkin classification is the most commonly used classification system. Controversies include the preferred surgical approach (anterior versus posterior) versus ganz safe surgical dislocation approach and whether to perform femoral head fragment excision or internal fixation. Presenting a case report of 28 years old young male with a motor vehicle road traffic accident and suffered a head of femur fracture on right hip joint with posterior wall of right acetabulum fracture with Judet-Letournel type posterior wall and type 4 Pipkin’s classification of femoral head fracture. This patient was undergone for emergency surgical intervention of open reduction, internal fixation through Ganz approach and insertion of Herbert screws for femoral head and interfragmentary screw for trochanteric osteotomy. The patient was followed up for 1 year and have a complete range of motion at hip joint with painless daily lifestyle. Type 4 Pipkin classification of femoral head fracture managed timely and with surgical intervention by ganz safe surgical dislocation approach provides visualization to femoral head and whole acetabulum with internal fixation of femur head by herbert screw which preserves normal anatomic contour of femoral head shows appropriate reduction of fracture fragments and it may also avoid hemiarthroplasty surgeries. Fracture of the femoral head has been associated with a relatively poor functional outcome and requires timely management and surgical intervention. Specially type 4 Pipkin classification of femoral head fracture treated by ganz safe surgical dislocation approach with internal fixation of femur head by herbert screw shows better outcome and avoid risk of AVN of femoral head. Complications associated with fracture of the femoral head and subsequent treatment include osteonecrosis, post-traumatic osteoarthritis, heterotopic ossification and implant failure.

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“… 1 – 3 In 1869, Birkett was the first to discover and document femoral head fractures while performing a post mortem dissection. 4 The infrequency of these fractures has made the study of large patient populations difficult, as most of the available literature comprises small studies and case series. However, the incidence of this rare injury has increased steadily in recent years, most likely due to the occurrence of a higher number of motor vehicle accidents in combination with an enhanced survival of polytraumatized patients due to improved safety features in modern vehicles.…”

Section: Introductionmentioning

confidence: 99%

Fractures of the femoral head: a narrative review

et al. 2021

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Fractures of the femoral head are rare injuries, which typically occur after posterior hip dislocation. The Pipkin classification, developed in 1957, is the most commonly used classification scheme to date. The injury is mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a significant height. Emergency treatment consists of urgent closed reduction of the hip joint, followed by non-operative or operative treatment of the femoral head fracture and any associated injuries. There is an ongoing controversy about the suitable surgical approach (anterior vs. posterior) for addressing fractures of the femoral head. Fracture location, degree of displacement, joint congruity and the presence of loose fragments, as well as concomitant injuries are crucial factors in choosing the adequate surgical approach. Long-term complications such as osteonecrosis of the femoral head, posttraumatic osteoarthritis and heterotopic ossification can lead to a relatively poor functional outcome. Cite this article: EFORT Open Rev 2021;6:1122-1131. DOI: 10.1302/2058-5241.6.210034

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THE CLASSIC: Description of a Dislocation of the Head of the Femur, Complicated With its Fracture; With Remarks by

Cited by 6 publications

References 0 publications

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

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

Functional outcome of type 4 Pipkin classification of femoral head fracture operated by open reduction internal fixation by ganz safe surgical dislocation approach management: a case report

Fractures of the femoral head: a narrative review

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