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, 12–18].
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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