A pipkin type IV injury treated with acetabular reconstruction and primary total hip replacement surgery: A case...

Acetabular fractures are uncommon and serious injuries to the hip joint occurring in 3 out of 100,000 individuals annually, commonly affects young people. In young individuals usually occurs from high-energy trauma and usually accompanied with associated injuries.

54 years old male involved in a motor traffic crash as a driver who had head-to-head collision with a tractor and sustained right hip injury and loss of consciousness for an unknown period of time. On admission pelvis X-ray and CT scan were done, he was diagnosed with 1. mild traumatic brain injury, 2. posterior hip dislocation with comminuted posterior wall acetabular fracture, and 3. femoral head fracture pipkin IV. E-fast was negative, chest X-ray revealed cardiomegaly, echocardiogram and electrocardiogram were unremarkable. He was kept on right distal femur skeletal traction temporarily, definitively acetabular reconstruction and total hip replacement were done.

Posterior wall acetabular fracture with posterior column fracture if treated with ORIF results into failed fixation in 31.8 %, osteoarthritis in 63.6 %. 46 % of patients above 50 yrs treated with ORIF will end up requiring a late total hip replacement. Early treatment with total hip replacement results into better outcome compared to total hip done secondary to posttraumatic arthritis and failed fixation.

Primary total hip replacement is a best treatment modality in patients with severely comminuted posterior wall acetabular fracture due to the fact that open reduction and internal fixation is associated with more complications and inferior outcome compared to early total hip replacement.