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[The Pipkin fracture]
1Ortopedické oddĕlení NsP a LDN, Orlová.
Insights
This study reviews Pipkin fracture treatment outcomes. Timely hip reduction and surgical approach are key to preventing complications like avascular necrosis.
Area of Science:
- Orthopedic Surgery
- Trauma Care
Context:
- Pipkin fractures involve fracture-dislocation of the femoral head.
- Dashboard injuries are a common cause in drivers and passengers.
Purpose:
- To present experience in treating Pipkin fractures.
- To evaluate treatment outcomes and recommend diagnostic and surgical strategies.
Summary:
- Eleven patients with Pipkin fractures were treated over 9 years.
- Surgical options included total hip arthroplasty and internal fixation.
- Four Type 2, four Type 3, and three Type 4 fractures were identified.
Impact:
- Recommends CT in addition to radiographs for diagnosis.
- Emphasizes prompt reduction (within 6 hours) to prevent avascular necrosis.
- Suggests the anterolateral approach for internal fixation or fragment extirpation.
Purpose Of The Study:
The authors present their experience in the treatment of fracture-dislocation of femoral head--the Pipkin fracture.
Material:
The group includes 11 patients treated in the period of 9 years (1991-2000). The average age was 46 years (range, 23-63 years). The average follow-up was 3.2 years (range, 6 months-9 years). According to the Pipkin classification four times we diagnosed Type 2, four times Type 3 (three times iatrogenic during closed reduction), three times Type 4. In 10 patients it was a case of a dashboard injury of drivers or passengers. In one patient it was industrial accident.
Methods:
Ten patients were treated surgically, of which six times total hip arthroplasty was primarily used. In three patients we reconstructed the fracture with internal fixation, of this in two patients with Type 2 fracture the fragment from the head was fixed by two and three Krischner wires. In one patient the fragment of the head was extirpated.
Results:
The evaluation after Thompson-Epstein included only five patients as the patients treated by total hip arthroplasty were excluded. Good result was recorded four times and poor result once.
Discussion:
As for diagnosis the authors recommend apart from standard radiographs also CT. The basis of the treatment of fracture-dislocations of femoral head is the reduction of the dislocated hip joint, optimally within 6 hours after the injury. A timely reduction prevents the onset of avascular necrosis of the femoral head. Another issue is the choice of an optimal surgical approach to the hip joint during the treatment of fracture of the Pipkin type. In all patients indicated to internal fixation or extirpation of the fragment the authors used anterolateral approach after Watson-Jones.
Conclusion:
In the conclusion the authors point out the possibility of the incidence of unfavourable third type of the Pipkin fractures during closed reduction of Types 1, 2 and 4.