Can a Traumatic Pipkin Fracture - Dislocation and Ipsilateral Knee Dislocation Occur Simultaneously? A Rare Case Report with Mid-Term Follow-Up

Abstract

Introduction: Simultaneous ipsilateral hip and knee dislocations are extremely rare, especially when associated with fractures, and present significant challenges in diagnosis and management. These injuries, often resulting from high-velocity trauma, require prompt intervention to tackle the complications and achieve a good outcome.

Case report: We present the case of a 28-year-old male who sustained an ipsilateral hip fracture dislocation and knee dislocation following a high-velocity road traffic accident. Initial clinical examination revealed significant deformities in both joints, and imaging confirmed posterior dislocation of the hip with an acetabular wall fracture and a posterior knee dislocation with an inferior pole patella fracture. Emergency closed reduction was performed within hours of the incident, followed by detailed imaging studies including computed tomography and magnetic resonance imaging. Surgical management involved open reduction and internal fixation of the femoral head and posterior acetabular wall reconstruction. Post-operative rehabilitation focused on joint mobility and strength, and the patient achieved full weight-bearing and near-complete range of motion by 18 months.

Discussion: The rare occurrence of simultaneous hip and knee dislocations necessitates careful management, with emphasis on early reduction and neurovascular assessment. This case highlights the challenges of managing such injuries, including the coordination of hip and knee reduction techniques and post-operative rehabilitation tailored to the patient's needs. Despite the complexity, timely intervention and individualized care can lead to favorable outcomes, even in severe trauma.

Conclusion: Ipsilateral hip and knee dislocations require urgent diagnosis and a multidisciplinary approach for optimal management. Prompt closed reduction, appropriate surgical intervention, and a tailored rehabilitation protocol are key to achieving good functional outcomes in these rare and complex injuries.

Keywords: Dislocation; ipsilateral hip; knee dislocation.

Figure 1

Plain radiograph of the hip joint showing posterior dislocation of the hip with femoral head and acetabulum fracture.

Figure 2

Plain radiograph of the knee joint showing posterior dislocation of the knee with inferior pole of patella fracture.

Figure 3

Radiograph showing concentric reduction of left hip joint.

Figure 4

Radiograph showing congruity of knee joint post-reduction.

Figure 5

Computed tomography coronal images of left hip showing femoral head fracture.

Figure 6

Computed tomography sagittal cut showing femoral head fracture.

Figure 7

(a): 3D reconstruction image showing posterior wall of the acetabulum fracture (b) 3D reconstruction image showing fracture of the femoral head.

Figure 8

(a and b) Intraoperative C-arm images of femoral head cannulated cancellous screw fixation.

Figure 9

Post-operative X-ray of the patient with femoral head cannulated cancellous screw in situ.

Figure 10

(a) Hip abduction at 18 months. (b) Hip extension at 18 months. (c) Knee and hip flexion at 18 months (d) able to sit crossed leg.