A treatment strategy to avoid iatrogenic Pipkin type III femoral head fracture-dislocations.
BACKGROUND
Reduction is urgently required in cases of traumatic hip dislocation to decrease the risk of avascular necrosis of the femoral head. However, successful reduction may not always be feasible for hip dislocations associated with femoral head fractures. This irreducibility may provoke further incidental fractures of the femoral neck with resultant Pipkin type III injuries. The purpose of this study was to describe an appropriate treatment strategy for irreducible femoral head fracture-dislocations.


METHODS
We treated nine patients with irreducible hip dislocations with femoral head fractures (eight Pipkin type II and one type IV) for which reduction failed in the emergency room or operating theater. All of these cases required operative management.


RESULTS
Five of the nine patients experienced femoral neck fractures after closed reduction were attempted. These five cases underwent joint replacement at the time of injury or after developing avascular necrosis of the femoral head. Analysis of radiographs and computed tomography (CT) scans revealed that the fractured femoral head was perched on the sharp angle of the posterior wall of the acetabulum in the irreducible hips. After recognizing the irreducibility, the other four cases underwent immediate open reduction without further attempts at closed reduction, which saved the natural hip joint without neck fracture or avascular necrosis.


CONCLUSIONS
Repeated or forceful closed reduction of irreducible femoral head fracture-dislocation injuries may result in iatrogenic femoral neck fractures with Pipkin type III injuries. Before attempting reduction, careful examination of plain radiographs and CT images may be helpful for determining the safest treatment strategy.
Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.
Kyeong-Hyeon
KH
Park
Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
Ji-Wan
JW
Kim
Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea. cwoh@knu.ac.kr.
Chang-Wug
CW
Oh
Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.
Joon-Woo
JW
Kim
Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea.
Jong-Keon
JK
Oh
Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.
Hee-Soo
HS
Kyung
D000328:Adult; D000368:Aged; D000070628:Closed Fracture Reduction / Q000009:adverse effects*; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging* / Q000293:injuries; D000072039:Fracture Dislocation / Q000209:etiology* / Q000517:prevention & control*; D006617:Hip Dislocation / Q000628:therapy*; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction
Femoral head fracture–dislocation; Iatrogenic femoral neck fracture; Irreducible hip dislocation; Pipkin type III