A rare case of an irreducible Pipkin II fracture–dislocation of the femoral head in a young patient following low-energy trauma

BACKGROUND Traumatic hip dislocation usually occurs following high-velocity trauma. It is imperative that the dislocation be reduced in a timely manner, especially in a closed manner, as an orthopedic emergency. However, closed reduction can hardly be achieved in patients who also have ipsilateral lower extremity fractures. Herein, we focus on hip dislocation associated with ipsilateral lower extremity fractures, excluding intracapsular fractures (femoral head and neck fractures), present an early closed hip joint reduction method for this injury pattern, and review the literature to discuss the appropriate closed reduction technique for this rare injury pattern. CASE SUMMARY We report a case of a 37-year-old male who sustained a left acetabular posterior wall fracture, an ipsilateral comminuted subtrochanteric fracture and dislocation of the hip. The hip dislocation was reduced urgently in a closed manner using the joy-stick technique with a T-shaped Schanz screw. The fractures were reduced and fixed as a 2nd-stage surgery procedure. At the 17-month postoperative follow-up, the patient had full range of motion of the affected hip. CONCLUSION Closed reduction of a hip dislocation associated with ipsilateral lower extremity fractures is rarely achieved by regular maneuvers. Attempts at closed reduction, by means of indirectly controlling the proximal fracture fragment or reconstructing the femoral leverage rapidly with the aid of various external reduction apparatuses, were shown to be effective in some scenarios. Mandatory open reduction is indicated in cases of failed closed reduction, particularly in irreducible dislocations.

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Management of Pipkin Type 3 Fracture-Dislocation in Young Adults: A Dilemma

Harna,

Saini,

Saini

2023

Journal of Arthroscopy and Joint Surgery

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Pipkin type 3 fracture-dislocation constitutes a rare subgroup of fractures involving the femoral neck and head fracture. The management is difficult and controversial, including osteosynthesis using Herbert or cancellous screws and hip replacement surgery. In this case report, a 26-year-old male suffered a road traffic accident leading to a hip fracture. Radiographs and computed tomography scan of the hip depicted three large fragments of the femur head, dislocated posteriorly along with the neck of femur fracture. Considering the needs of the patient, fracture morphology, and unpredictable results of the osteosynthesis, the patient was treated primarily with uncemented total hip replacement. The complexity of the fracture leads to more chances of malreduction and avascular necrosis of the femur head. The patient had an uneventful intra and postoperative period. At the 3-year follow-up, the patient was walking unaided, pain-free, and performing all the activities of daily living satisfactorily.

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A rare case of an irreducible Pipkin II fracture–dislocation of the femoral head in a young patient following low-energy trauma

Cited by 3 publications

References 19 publications

Irreducible posterior fracture-dislocation of the hip associated with an ipsilateral femoral shaft fracture: A case report and review of the literature

Irreducible posterior fracture-dislocation of the hip associated with an ipsilateral femoral shaft fracture: A case report and review of the literature

Closed reduction of hip dislocation associated with ipsilateral lower extremity fractures: A case report and review of the literature

Management of Pipkin Type 3 Fracture-Dislocation in Young Adults: A Dilemma

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