PMC6854175_01
CT-scan of the pelvis showing a femoral head fracture associated with a posterior hip dislocation.
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II Pipkin fracture following a motorcycle accident (Figure 1). In the emergency department, an emergent close reduction under fluoroscopy was performed, followed by definitive surgical treatment five days after the initial injury.
Intraoperative exposure of the femoral head through a surgical hip dislocation approach and intraoperative assessment of femoral head vascularization performed with K-wire perforation.
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Regarding the Pipkin fracture, we chose to perform an anatomical reduction and internal fixation (Figure 2), using a surgical hip dislocation as described by Ganz et al.. We additionally verified the viability for the femoral head, performing perforations with a small K-wire as preconized in literature (Figure 2).
Femoral head fragment and its rigid fixation with 3 subchondral cannulated screws.
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The osteosynthesis was achieved using three subchondral headless cannulated screws (Figure 3), the capsule was closed with Vicryl 2-0 sutures, and the greater trochanter stabilized using two 3.5 mm cortical screws (Figure 4).
Trochanteric fixation with two 3.5 mm cortical screws.
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The osteosynthesis was achieved using three subchondral headless cannulated screws (Figure 3), the capsule was closed with Vicryl 2-0 sutures, and the greater trochanter stabilized using two 3.5 mm cortical screws (Figure 4).
Simple anteroposterior radiograph showing supratrochanteric heterotopic ossification at 3 years of follow-up, with a good active motion of the hip and painless hip flexion.
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Five months later, the patient was able to walk without crutches and painless range of motion (Figure 5). Nonetheless, a Brooker grade II heterotopic ossification could be identified in the radiographs (Figure 5).