Pipkin fractures: epidemiology and outcome

To describe the epidemiology of Pipkin fractures including detailed fracture classification and outcome for joint preservation and death.

We extracted data on all Pipkin fractures in the Swedish Fracture Register from 2013 to 2020 in patients ≥ 18 years. The cohort was cross-matched with the Swedish Hip Arthroplasty Register to obtain data on primary or secondary treatment with arthroplasty. We analysed data on age, sex, injury mechanism, fracture classification, treatment including secondary operative treatment with arthroplasty and mortality. Primary outcome was joint preservation.

In total 47 Pipkin fractures with a median age of 48 years were included. 74% of the fractures were in males. The median follow-up time was 3.5 years. The most common primary treatment was internal fixation (45%), followed by primary arthroplasty (28%), and excision of fragment (15%). Three of the 34 patients with primary non arthroplasty treatment received secondary treatment with arthroplasty. Two patients died within 30 days, and no further deaths occurred up to 1 year after injury.

Three of four fractures occurred in males and more than half of the fractures were due to high energetic injuries. Half of the patients received internal fixation (predominantly younger patients) and 28% were treated with primary arthroplasty (predominantly older patients). The revision rate was low, and after secondary treatment with arthroplasty two thirds of the patients still had a preserved joint.