Treatment of type IV Pipkin fracture in patients with a high BMI via hip arthroscopy-assisted surgery: a case report

Abstract

Pipkin type IV femoral head (FH) fracture–dislocations are usually treated via open surgery. There are many surgical approaches for the treatment of this difficult fracture depending on the fracture pattern. Obesity presents another challenging problem in surgical treatment and sometimes leads to a poorer outcome. We discuss herein a patient of a high body mass index (BMI) with a Pipkin type IV FH fracture who underwent open reduction internal fixation (ORIF) of anacetabular fracture with reconstruction plates and hip arthroscopy-assisted fixation of the FH fracture with two Herbert screws via the posterior approach. The intra-articular osteochondral loose bodies were excised by hip arthroscopy simultaneously. The joint congruency and screw positions were checked during surgery by arthroscopy. After 6 months, clinical and computed tomography (CT) follow-ups showed excellent results. The patient of a high BMI recovered immediately and had a satisfactory short-term outcome after hip arthroscopy-assisted surgery. We concluded that hip arthroscopy-assisted surgery is a viable option for the treatment of Pipkin type IV FH fracture–dislocations.

Repair of a Femoral Head Fracture Dislocation With an Associated Posterior Wall Acetabular Fracture (Pipkin 4) via a Kocher–Langenbeck Approach

“…1,2 Previous literature on these injuries report poor functional outcomes and high rates of postoperative complications. [3][4][5][6][7][8] Surgical techniques used to treat combined femoral head and posterior wall acetabular fracture dislocations include surgical hip dislocation performed through a Kocher-Langenbeck approach or Gibson approach. This patient underwent operative repair of his Pipkin IV femoral head-posterior wall acetabular fracture through a standard Kocher-Langenbeck approach without a trochanteric osteotomy, and the surgical hip dislocation was performed through the large posterior wall defect.…”

“…1,2 Previous literature on these injuries report poor functional outcomes and high rates of postoperative complications. 3–8…”