Posterior wall acetabulum fracture-dislocation with subsequent ipsilateral pipkin IV fracture-dislocation: How many hits can a hip take?

Pipkin IV fracture dislocation of the hip in a football athlete - A case report

Pipkin type IV fracture dislocation of the hip is a rare, high-energy injury, that is associated with poor functional outcomes and complications. We report a case of a 20-year old male quarterback who sustained a Pipkin type IV fracture dislocation during a football game. He underwent immediate closed reduction, transfer to a Level I trauma centre, surgical management, and progressive rehabilitation. Clinical and radiographic assessments were carried out periodically for 1 year. At 10 months post-injury, the athlete returned to full-time play as the starting quarterback of his University football team. He completed a pain-free season at 1-year post-injury. Clinical and radiographic evaluations demonstrated appropriate healing with no complications. Despite the high-energy and often devastating nature of Pipkin Type IV injuries, this case report demonstrates that prompt, appropriate management and rehabilitation of this injury in a University quarterback led to positive functional outcomes. Further studies on the treatment and outcomes of this rare sport injury are needed to optimize management.

A combination of the K-L and S-P approaches for treating acetabular posterior wall factures accompanied by femoral head fractures with open reduction and internal fixation

Background

In clinical practice, acetabular posterior wall fracture combined with femoral head fracture is rare. However, with the increasing number of engineering and traffic accidents, such fractures, have increased significantly in recent years. This paper aims to explore the clinical efficiency of the Kocher-Langenbeck (K-L) and Smith-Petersen (S-P) combined approaches for open reduction and internal fixation (ORIF) of acetabular posterior wall fractures accompanied by femoral head fractures (Pipkin type IV fractures).

Methods

A retrospective study was conducted on 8 patients who underwent open reduction and internal fixation (ORIF) of Pipkin type IV fractures through the K-L combined with S-P approach in our hospital from January 2015 to January 2020. All 8 patients were successfully operated on without serious complications, such as important blood vessel and nerve damage, with an operation time of 143.8 ± 44.38 min and intraoperative blood loss of 225 ± 70.71 ml. Perioperative data were recorded. The Harris score was used to evaluate the clinical effect. Fracture reduction quality was evaluated according to the Matta radiological standard. The grade of ectopic ossification was evaluated by the Brooker grading method, and the stage of femoral head necrosis was evaluated by Ficat-Arlet staging.

Results

The Harris score increased significantly from 57.38 ± 4.779 at 3 months, to 76.13 ± 3.682 at 6 months, 88.25 ± 3.495 at 12 months, and 92.13 ± 2.232 at 36 months postoperatively. After statistical analysis, compared with the previous observation time point, the data comparison differences between the groups were statistically significant. P < 0.001, P < 0.001, P < 0.05). By the time of the latest follow-up, 6 of the 8 patients had recovered to the level of pre-injury sports capacity. In contrast, the other 2 patients remained below the level of pre-injury sports capacity. In terms of imaging evaluation, the quality of fracture reduction on radiographs was graded as excellent in 6 patients and good in 2 patients according to Matta’s criteria. At the last follow-up, no heterotopic ossification or femoral head necrosis was found in of all the images. In addition, the hip joint space was normal in 6 cases, mildly narrowed in 1 case, and clearly narrowed in 1 case.

Conclusions

The K-L combined with S-P approach provides effective exposure for the reduction and fixation of Pipkin type IV fractures and achieves satisfactory clinical outcomes.

Supplementary information

The online version contains supplementary material available at 10.1186/s12893-022-01597-w.

Repeat posterior wall acetabular fracture-dislocation: High-energy trauma as a 'second hit phenomenon'

Acetabular fractures are injuries that require significant force transmission, especially when associated with a femoral head dislocation. The mechanism of injury is typically in the setting of a high-speed motor vehicle collision. In a similar manner, this is an injury that is highly demanding for the orthopaedic trauma surgeon to treat as well. We present a patient who sustained an initial posterior wall acetabular fracture with an associated posterior dislocation. This was treated surgically with open reduction, internal fixation without complication. The patient subsequently sustained a second posterior wall acetabular fracture with dislocation fifteen years later through the plated and healed previous fracture. Both injuries were sustained in high-speed motor vehicle collisions, so it is difficult to presume the patient was predisposed for the repeat injury. At any rate, the repeat injury makes the surgical management significantly more challenging. In complicated acetabular fractures like these, a post or intra-operative CT scan can be of utility to determine quality of reduction as well as assessing for retained bony fragments. Our patient underwent a post-operative CT scan with the finding of intra-articular bony fragments that subsequently required arthroscopic removal. Given the rare nature of this complicated injury occurring twice in a patient, it is difficult to make evidence-based comments on long-term prognosis and functional outcomes. This unique case and the applied treatment will serve as a guide for future similar cases.