Pipkin Fractures


Type

Description

1A

Dislocation with fracture distal to the fovea capitis femoris

1B

Dislocation with fracture distal to the fovea capitis femoris associated with an acetabular fracture

2A

Dislocation with fracture proximal to the fovea capitis femoris

2B

Dislocation with fracture proximal to the fovea capitis femoris associated with an acetabular fracture

3A

Dislocation with fracture distal to the fovea capitis femoris associated with a femoral neck fracture

3B

Dislocation with fracture proximal to the fovea capitis femoris associated with a femoral neck fracture

4A

Anterior dislocation with impaction of the femoral head

4B

Anterior dislocation with fracture proximal to the fovea capitis femoris

5

Central dislocation with fracture of the femoral head



The AO classification 31 C1, 2, 3 describes the shorn-off fragment, the impaction of the femoral head, the dislocation, as well as the concomitant femoral neck fracture (31 C3.3), but it does not consider a concomitant acetabular fracture [10].



18.5 Treatment and Complications


The most important step in the treatment of a dislocation is an early reduction of the hip joint within 6 h after the accident. If a closed reduction is not possible, an open reduction of the fracture, including all necessary operative steps, must be performed. After reduction of the joint, a control X-ray or, if possible, a CT scan of the fracture with an additional 3D reconstruction, must be performed.

The therapeutic algorithm and possible complications can be seen in the Table 18.1 [1, 4, 5, 8, 1218].



Table 18.1





























































Type of fracture

Treatment method

Approach

Follow-up

Complications

Pipkin 1/Brumback 1A/AO 31 C1.2

(a) Conservative (1)
 
Bed rest for 14 days followed by non-weight bearing for 6 weeks

Osteoarthrosis, AVN

b) Operative (2): fragment excision,…, ORIF

1. Dorsal

Non-weight bearing for 6 weeks

Osteoarthrosis, AVN

2. Ventral #

Non-weight bearing for 6 weeks

Pipkin 2/Brumback 2A/AO C1.3

(a) Conservative (1)
 
Bed rest for 6 weeks followed by non-weight bearing for 6 weeks

Secondary dislocation, osteoarthrosis, AVN

(b) Operative (2): ORIF, “The fragment attached to the lig. teres must not be disconnected”

1. Dorsal

Non-weight bearing for 12 weeks*

Secondary dislocation, resorption, osteoarthrosis, AVN

2. Ventral #
 

Pipkin 3/Brumback 3B/AO C3.2

Operative: biological age of the patient is decisive

Postero-lateral approach is the rule, as an anterior dislocation in combination with these fractures is an exception

Non-weight bearing for 12 weeks*

High incidence of AVN

ORIF: early osteosynthesis (+) in younger patients “The femoral neck fracture has to be fixed prior to femoral head reduction!”
 
Hip replacement in elderly patients (hemi- or total hip arthroplasty) (++)
 
Type of mobilization depends on the concomitant injuries, full-weight bearing is usually possible

Depends on the implantation technique

Pipkin 4/Brumback 1B, 2B, 4B, 5/AO (?)

Operative: ORIF – management of the acetabular fracture and the fracture of the femoral head (+)

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Mar 18, 2017 | Posted by in SPORT MEDICINE | Comments Off on Pipkin Fractures

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