外科ジャーナル

Treatment Options in Pipkin Fracture-Dislocation of the Femoral Head: Cases Review

Abstract

Ovidiu Alexa, Bogdan Puha, Dragos Popescu, Radu Ioan Malancea and Bogdan Veliceasa

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.