PMC6664009_01
Clinical photograph of the patient, with hip flexion and internal rotation.
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However, both hips were deformed in flexion, internal rotation and adduction (Fig. 1), without neurovascular deficit or skin lesions of the lower limbs.
Anteroposterior radiograph of the pelvis showing bilateral posterior hip dislocation with right Pipkin type II fracture.
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Radiographs displayed bilateral posterior hip dislocation combined with right femoral head fracture, and small posterior wall fracture of the left acetabulum. (Fig. 2) Prompt hips reduction was performed within one hour of presentation through closed manipulation below general anesthesia, curarisation and controlled by fluoroscopy, patient was maintained in supine position on the ground and the aide applied a hand pression on the iliac wings of the pelvis, while the operator exerted a traction on the leg then flexed the hip with adduction and external rotation, the same technique was applied successfully to the second hip.
Immediate pelvic X-ray showing a non-reduction of right hip because of a non-reduced Pipkin II fragment (blue arrow) with a small superior fragment (red arrow).
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Reduction of each hip was checked by antero-posterior pelvic radiograph (Fig. 3) and CT-scan (Fig. 4).
Hardinge approach to the right hip allowing osteosynthesis of Pipkin's fracture with two Herbert screws.
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T-shaped capsulotomy was performed to release the anterior capsule. The hip joint was then dislocated, and the femoral head fracture was exposed, we have explored a rotated pipkin II fragment and extracted two small parts that had footprints in the not weight bearing area in the distal part of the femoral head (Fig. 5).
pelvic post-operative X-ray showing the Herbert screws fixation and good anatomic hip reduction.
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Pipkin fragment and fixed them by two small pins that was over-drilled with a cannulated drill bit, followed by osteosynthesis with two Herbert screws, then hip was reduced and the flaps was repaired by transosseuses sutures to the great trochanter layer by layer using a vicryl number 2. Postoperative examination revealed no neurological deficit and the postoperative imaging of the pelvis showed an anatomic reduction of the femoral head fracture and a good position of the two Herbert screws (Fig. 6).
clinical examination of lower limbs and the skin incision of modified Hardinge approach.
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At 6 months there was a good fracture healing, the patient had no limited hip motion, without limping and normal return to his daily activity (Fig. 7).
two years pelvic post-operative X-ray showing absence of osteoarthritis or avascular necrosis signs, but a right hip non-bridging Brooker type I heterotopic ossification was noticed.
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However, a right hip non-bridging Brooker type I heterotopic ossification was noticed (Fig. 8).