Characteristics and clinical significance of irreducible Pipkin type <b>Ⅰ</b> and <b>Ⅱ</b> femoral head fracture-dislocations_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Haoran , JI Zhengang , ZHOU Zhibin , SONG Xia’nan ,  HAN Tianyu

Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang Liaoning, 110016, P. R. China;

Corresponding author：

HAN Tianyu, Email: fmmuhty@sina.com

Keywords：

Dislocation of hip joint; closed reduction; femoral head fracture; femoral neck fracture; osteonecrosis of the femoral head

DOI：

10.7507/1002-1892.202108056

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Objective To summarize the characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. Methods The clinical data of 4 patients with irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations between January 2010 and December 2019 were collected. There were 2 males and 2 females and the age ranged from 24 to 41 years, with an average age of 33.5 years. The cause of injury included traffic accident in 3 cases and falling in 1 case. Pipkin classification was 2 cases of type Ⅰ and 2 cases of type Ⅱ. The time from injury to operation was 1-2 days. The clinical features were that the hip joint of the affected limb was in a locked position, and the passive range of motion was poor. The affected limb was slightly flexed at the hip joint and shortened, in a state of neutral position or slight adduction and internal rotation. The imaging data suggested that the femoral head dislocated backward and upward, and the hard cortex of the posterior edge of the acetabulum was embedded in the cancellous bone of the femoral head, and the two were compressed and incarcerated. Patients of cases 1-3 underwent closed reduction of hip dislocation 1-2 times at 3, 1, and 3 hours after injury respectively, and femoral neck fracture occurred. The injury types changed to Pipkin type Ⅲ, and open reduction and internal fixation were performed. Patient of case 4 did not undergo closed reduction, but underwent open reduction and internal fixation directly. Results Patients of cases 1-3 were followed up 14, 17, and 12 months, respectively. They developed osteonecrosis of the femoral head at 9, 5, and 10 months after operation respectively, and all underwent total hip arthroplasty. Patient of case 4 was followed up 24 months and had no hip pain and limited mobility; the imaging data indicated that the internal fixator position was good and the fracture healed; no collapse or deformation of the femoral head was seen, and no osteonecrosis of the femoral head occurred. Conclusion Clinicians need to improve their understanding of the unique clinical features and imaging findings of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. It is suggested that open reduction and simultaneous fixation of femoral head fracture should be directly used to reduce the incidence of osteonecrosis of the femoral head.

Citation： WANG Haoran, JI Zhengang, ZHOU Zhibin, SONG Xia’nan, HAN Tianyu. Characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 263-267. doi: 10.7507/1002-1892.202108056 Copy

1.	Chen W, Gao Z, Ma L. Failed reduction of posterior hip dislocation accompanied by femoral head fracture: causes and resolving strategy. Int Orthop, 2021, 45(6): 1609-1614.
2.	Hegde A, Mane PP, Khanna V, et al. Post-traumatic bilateral posterior hip dislocations with femoral head fracture on one side and acetabular fracture on the other side: a very rare presentation. BMJ Case Rep, 2021, 14(1): e239339. doi: 10.1136/bcr-2020-239339.
3.	Cooper J, Tilan J, Rounds AD, et al. Hip dislocations and concurrent injuries in motor vehicle collisions. Injury, 2018, 49(7): 1297-1301.
4.	Gavaskar AS, Srinivasan P, Jeyakumar B, et al. Surgical dislocation or the modified heuter anterior approach for Pipkin Ⅰ and Ⅱ femoral head fracture dislocations. J Orthop Trauma, 2020, 34(12): 626-631.
5.	Khalifa AA, Haridy MA, Fergany A. Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis. World J Orthop, 2021, 12(8): 604-619.
6.	徐松, 叶哲伟, 曹英豪, 等. 改良Smith-Petersen入路复位内固定治疗股骨头骨折的疗效. 中华创伤杂志, 2020, 36(8): 686-691.
7.	Rana R, Verma D, Behera S, et al. Irreducible femur head fracture-dislocation treatment with Kocher-Langenbeck approach with flip trochanteric osteotomy: A novel approach. Cureus, 2020, 12(12): e11969. doi: 10.7759/cureus.11969.
8.	Kokubo Y, Uchida K, Takeno K, et al. Dislocated intra-articular femoral head fracture associated with fracture-dislocation of the hip and acetabulum: report of 12 cases and technical notes on surgical intervention. Eur J Orthop Surg Traumatol, 2013, 23(5): 557-564.
9.	赵道洪, 胡卫平, 赵波, 等. 关节镜下复位固定盂唇骨性Bankart损伤治疗难复性髋关节后脱位. 中国修复重建外科杂志, 2019, 33(6): 676-680.
10.	Alyousif H, Aleisawi H, Alkaff H, et al. Terrible triad of the hip: A case report. Int J Surg Case Rep, 2021, 82: 105758. doi: 10.1016/j.ijscr.2021.105758.
11.	Lawrence DA, Smitaman E, Baumgartner M, et al. A rare but radiographically recognizable cause of an irreducible hip fracture-dislocation. Clin Imaging, 2013, 37(3): 595-597.
12.	Mehta S, Routt ML. Irreducible fracture-dislocations of the femoral head without posterior wall acetabular fractures. J Orthop Trauma, 2008, 22(10): 686-692.
13.	Park KH, Kim JW, Oh CW, et al. A treatment strategy to avoid iatrogenic Pipkin type Ⅲ femoral head fracture-dislocations. Arch Orthop Trauma Surg, 2016, 136(8): 1107-1113.
14.	Uzel AP, Laflamme GY, Rouvillain JL. Irreducible Pipkin Ⅱ femoral head fractures: Is transgluteal approach the best strategy? Orthop Traumatol Surg Res, 2010, 96(6): 695-701.
15.	Keong MW, Razak HRBA, Koon WM, et al. Case report of a rare Pipkin type Ⅲ femoral head fracture. J Orthop Case Rep, 2019, 9(5): 11-15.
16.	Sy MH, Kinkpé CV, Dakouré PW, et al. Femoral neck fracture complicating orthopedic reposition of a dislocated hip: four cases. Rev Chir Orthop Reparatrice Appar Mot, 2005, 91(2): 173-179.
17.	Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12): 1245-1251.
18.	Tripathy SK, Das SS, Rana R, et al. Trochanteric osteotomy for safe surgical approach to bilateral hip dislocations with femoral head fractures. J Clin Orthop Trauma, 2020, 11(Suppl 4): S530-S533.

1. Chen W, Gao Z, Ma L. Failed reduction of posterior hip dislocation accompanied by femoral head fracture: causes and resolving strategy. Int Orthop, 2021, 45(6): 1609-1614.
2. Hegde A, Mane PP, Khanna V, et al. Post-traumatic bilateral posterior hip dislocations with femoral head fracture on one side and acetabular fracture on the other side: a very rare presentation. BMJ Case Rep, 2021, 14(1): e239339. doi: 10.1136/bcr-2020-239339.
3. Cooper J, Tilan J, Rounds AD, et al. Hip dislocations and concurrent injuries in motor vehicle collisions. Injury, 2018, 49(7): 1297-1301.
4. Gavaskar AS, Srinivasan P, Jeyakumar B, et al. Surgical dislocation or the modified heuter anterior approach for Pipkin Ⅰ and Ⅱ femoral head fracture dislocations. J Orthop Trauma, 2020, 34(12): 626-631.
5. Khalifa AA, Haridy MA, Fergany A. Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis. World J Orthop, 2021, 12(8): 604-619.
6. 徐松, 叶哲伟, 曹英豪, 等. 改良Smith-Petersen入路复位内固定治疗股骨头骨折的疗效. 中华创伤杂志, 2020, 36(8): 686-691.
7. Rana R, Verma D, Behera S, et al. Irreducible femur head fracture-dislocation treatment with Kocher-Langenbeck approach with flip trochanteric osteotomy: A novel approach. Cureus, 2020, 12(12): e11969. doi: 10.7759/cureus.11969.
8. Kokubo Y, Uchida K, Takeno K, et al. Dislocated intra-articular femoral head fracture associated with fracture-dislocation of the hip and acetabulum: report of 12 cases and technical notes on surgical intervention. Eur J Orthop Surg Traumatol, 2013, 23(5): 557-564.
9. 赵道洪, 胡卫平, 赵波, 等. 关节镜下复位固定盂唇骨性Bankart损伤治疗难复性髋关节后脱位. 中国修复重建外科杂志, 2019, 33(6): 676-680.
10. Alyousif H, Aleisawi H, Alkaff H, et al. Terrible triad of the hip: A case report. Int J Surg Case Rep, 2021, 82: 105758. doi: 10.1016/j.ijscr.2021.105758.
11. Lawrence DA, Smitaman E, Baumgartner M, et al. A rare but radiographically recognizable cause of an irreducible hip fracture-dislocation. Clin Imaging, 2013, 37(3): 595-597.
12. Mehta S, Routt ML. Irreducible fracture-dislocations of the femoral head without posterior wall acetabular fractures. J Orthop Trauma, 2008, 22(10): 686-692.
13. Park KH, Kim JW, Oh CW, et al. A treatment strategy to avoid iatrogenic Pipkin type Ⅲ femoral head fracture-dislocations. Arch Orthop Trauma Surg, 2016, 136(8): 1107-1113.
14. Uzel AP, Laflamme GY, Rouvillain JL. Irreducible Pipkin Ⅱ femoral head fractures: Is transgluteal approach the best strategy? Orthop Traumatol Surg Res, 2010, 96(6): 695-701.
15. Keong MW, Razak HRBA, Koon WM, et al. Case report of a rare Pipkin type Ⅲ femoral head fracture. J Orthop Case Rep, 2019, 9(5): 11-15.
16. Sy MH, Kinkpé CV, Dakouré PW, et al. Femoral neck fracture complicating orthopedic reposition of a dislocated hip: four cases. Rev Chir Orthop Reparatrice Appar Mot, 2005, 91(2): 173-179.
17. Giannoudis PV, Kontakis G, Christoforakis Z, et al. Management, complications and clinical results of femoral head fractures. Injury, 2009, 40(12): 1245-1251.
18. Tripathy SK, Das SS, Rana R, et al. Trochanteric osteotomy for safe surgical approach to bilateral hip dislocations with femoral head fractures. J Clin Orthop Trauma, 2020, 11(Suppl 4): S530-S533.

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Characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations

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