Classifications in Brief: The Pipkin Classification of Femoral Head Fractures

Romeo, Nicholas M.; Firoozabadi, Reza

doi:10.1007/s11999.0000000000000045

Cited by 37 publications

(35 citation statements)

References 17 publications

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“…Femoral neck fractures combined with anterior dislocation of the femoral head are very rare [ 17 , 18 , 32 ]. It is usually caused by a high-energy injury [ 33 ], most often seen in traffic accidents among young adults.…”

Section: Discussionmentioning

confidence: 99%

Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification

Liu

Ding

et al. 2021

BMC Musculoskelet Disord

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Background Femoral neck fracture combined with anterior dislocation of the femoral head is very rare. To our knowledge, there is no classification system yet for this rare form of injury, and the injury mechanism of femoral neck fracture combined with obturator head dislocation has not been described in the literature. In this study, we systematically reviewed the literature and the cases treated in our hospital, and identified and classified all injury types according to the injury mechanism of femoral neck fracture combined with anterior dislocation of the femoral head. Further, based on the experience of treating a patient with femoral neck fracture and obturator dislocation of the femoral head, a theoretical hypothesis was proposed for the injury mechanism of this rare type of injury. Methods A comprehensive search was conducted on PubMed, WOS, CNKI database. These fractures were classified according to the dislocation site and injury mechanism (one injury or two injuries). Results 1891 articles were initially identified through PubMed and other databases, and after bibliographic research, study screening, and removing duplicates, 1455 articles were selected. After applying the exclusion criteria, a total of 18 full-text articles describing femoral neck fractures combined with anterior dislocation of the femoral head. Different dislocation sites have different injury mechanisms. Our classification system, to the best of the authors’ knowledge, allowed us to include all types of femoral neck fractures combined with anterior dislocation of the femoral head from the literature. According to the proposed classification system, the morphological features of femoral neck fracture combined with anterior dislocation of the femoral head can be accurately conveyed between doctors. Conclusions All injury patterns can likely be identified using the proposed classification system. This can help avoid confusion in the nomenclature of femoral neck fractures combined with anterior dislocation of the femoral head and help surgeons to more accurately detect lesions, thereby guiding surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification

Liu

Ding

et al. 2021

BMC Musculoskelet Disord

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“…The results indicate a better outcome with Pipkin type I and type II fractures when compared to Pipkin III and IV fractures, providing a crude validity to the classification system. 25 However, no studies have reported on the inter-observer and intra-observer reliability, which is most likely due to the infrequency of these injuries, with data only limited to small case series. Some authors regard the Brumback classification as more accurate and clinically valid, when compared to the Pipkin classification.…”

Section: Classification Systemsmentioning

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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“…[ 3 ] According to the classification system, Pipkin type III injuries constitute a subgroup of femoral head fractures associated with ipsilateral femoral neck fractures (FNFs). [ 4 ] As the least common 1, Pipkin Type-III injuries contributed to 8.6% of all the Pipkin fractures. Restricted by the complexity of the reconstruction of the natural hip joint, Pipkin type III fractures presented a worse prognosis than Pipkin type I or II fractures.…”

Section: Introductionmentioning

confidence: 99%

Case report of a delayed iatrogenic Pipkin type III femoral head fracture-dislocation

Zhou

2022

Medicine

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Rationale Pipkin III femoral head fracture dislocation (FHFD) is rarely observed in clinical practice, and its outcome is alarming. A considerable proportion of Pipkin III fractures result from repeated or forceful closed reduction of an irreducible FHFD. Pipkin type III fractures pose a therapeutic challenge. Most patients underwent total hip arthroplasty. Patient concerns A 34-year-old man experienced high-energy trauma to the left hip from a terrible traffic accident. Radiography and computed tomography (CT) at the local hospital revealed a left posterior FHFD. Emergency close reduction of the hip was performed.48 hours later, the patient was transferred to our institution. New radiography and CT examinations demonstrated an iatrogenic femoral neck fracture (FNF) associated with FHFD. In addition, a right talar fracture was observed. Diagnosis Pipkin III fracture combined with contralateral talar fracture. Interventions Considering his Pipkin fracture classification (Pipkin Type-III) and the time to surgery after his injury (>48 hours), the patient underwent left total hip arthroplasty uneventfully, followed by below-ankle plaster cast immobilization for his right ankle. Outcomes At the 6-month follow-up, the patient was able to walk pain-free, and plain radiographs were satisfactory, with no evidence of heterotopic ossification or osteonecrosis of the talus. Lessons Before emergency closed reduction, early recognition of the unique characteristics of an irreducible FHFD is essential to avoid iatrogenic femoral neck fracture.

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Classifications in Brief: The Pipkin Classification of Femoral Head Fractures

Cited by 37 publications

References 17 publications

Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification

Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification

Fractures of the femoral head: a narrative review

Case report of a delayed iatrogenic Pipkin type III femoral head fracture-dislocation

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