Treatment of Pipkin fractures

Because of the controversy that exists about therapy for the Pipkin fracture, the treatment and results of 117 fractures of the femoral head were reviewed and re-evaluated at least 1 year after the trauma had taken place. The cases were taken from eight publications in the literature from 1983 to 1995. The lesions in this collection comprised 35 % (n = 41) type I, 40 % (n = 47) type II, 10 % (n = 12) type III and 15 % (n = 17) type IV fractures classified after the Pipkin system. Seventy-four percent of patients (n = 87) were operated on; only type I lesions were treated conservatively in 42 %, thus more often than average. There were 57 complications with equally frequent head necroses (14.5 %) and severe coxarthroses. Coxarthrosis was doubled after conservative treatment versus operation (23 % vs. 13 %). There was no difference in respect to head necrosis. Postoperatively, 18 (14 %) periarticular ossifications were registered. Forty-one (75 %) of 55 Pipkin I and II fractures had an at least "good" outcome; the portion of conservative treatment was highter than operative treatment (88 % vs 69 %). Still these results have to be seen with respect to the use of treating simple lesions primarily conservatively with the minimum of 6 weeks of traction therapy, thus counting the latter patients in this group. According to the literature, we think that if there are no vital contraindications, all Pipkin fractures should be treated operatively (early emergency operation) by reattaching bigger fragments and extracting smaller fragments in Pipkin I and II fractures, trying to save the heads in young, active patients with Pipkin III fractures in contrast to primary endoprotheses in elderly patients with coxarthrosis with Pipkin IV fractures (unstable and displaced fractures of the acetabulum).