Neglected Pipkin's fracture dislocation with bilateral femoral shaft fractures: an unusual combination

Abstract

A hip fracture dislocation with contralateral femur fracture is a rare combination. We report a case of neglected posterior dislocation of hip with Pipkins-II femoral head and medial condylar fractures associated with a contralateral femoral shaft fracture. Right hip joint was approached via the Kocher-Langenbeck, following reduction, femoral head fragments were fixed with two 4-mm cannulated cancellous screws with open reduction internal fixation plating of ipsilateral femoral condylar fracture and closed reduction internal fixation nailing of left femur in the same sitting. Immediate postoperative X-rays were satisfactory. Postoperative period was uneventful. Over 7-year follow-up, patient is successfully performing his duties with X-rays bearing no signs of avascular necrosis (AVN) or hip arthritis. Thus, complex femoral fractures require a multidisciplinary approach for successful treatment. Early congruous reduction, anatomical fixation and early rehabilitation help in reducing the incidence of AVN and postoperative arthritis. Successful diagnosis of Pipkin's fracture dislocations requires use of CT, MRI and ultrasound in adjunct to X-rays.

Figure 1:

Initial X-ray: pelvis with both hips (anteroposterior view).

Figure 2:

Initial X-ray: left thigh (anteroposterior view) and right knee (oblique view).

Figure 3:

Initial CT scan: Pipkin's fracture (white arrow) with posterior dislocation right hip.

Figure 4:

Intraoperative photograph: fracture fragments.

Figure 5:

Intraoperative photograph: femoral head screw fixation.

Figure 6:

Immediate postoperative X-ray.

Figure 7:

Postoperative X-ray at 1-year follow-up.

Figure 8:

Postoperative X-ray at 7-year follow-up.

Figure 9:

Clinical photograph at 7-year follow-up (cross leg sitting).

Figure 10:

Clinical photograph at 7-year follow-up (squatting).