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

Fractures of the femoral head associated with a hip dislocation are relatively rare and often associated with a poor functional outcome [1]. Keely and Lipscomb reported that the incidence of this type of femoral head fracture is two cases per one million per year [2]. Treatment strategies in femoral head fracture-dislocations are very controversial and represent one of the few true orthopedic emergencies reduction must be done as soon as possible under general anesthesia with good muscle relaxation to prevent further damage. After reduction, careful examination on multislice computed tomography (CT) should be performed for assessing reduction quality, comminution and free intraarticular fragments [3]. Conservative treatment is accepted only when post-reduction CT demonstrates anatomical reduction [4]. Closed non-surgical treatment can be the best option for Pipkin type I and type II fractures. If closed reduction is not appropriate, open reduction and internal fixation (ORIF) should be the choice of treatment [5]. Type IV Pipkin fractures should be treated surgically by ORIF of the acetabular fracture and fixation or excision of the femoral head fragments. In the past two years, we had nine cases of type I, II and IV Pipkin femoral head fracture-dislocations.