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Assuming the images represent isolated injuries, which of the following Figures demonstrates a Pipkin II femoral head fracture?
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Figure D represents a Pipkin II femoral head fracture, which is defined as a fracture which is superior to the fovea. Differentiation between Pipkin I and Pipkin II fractures can be important, as suprafoveal injuries often require surgical fixation. Illustration A demonstrates the Pipkin fracture types.
Droll et al review femoral head fracture evaluation and treatment. They discuss non-operative indications (typically reserved for Pipkin I injuries) which include an anatomic or near anatomic reduction (<2 mm) of the femoral head fragment, a stable hip, and no interposed fragments preventing a congruent hip joint. They also state that an anterior surgical approach is preferred for fixation of Pipkin II type injuries.
Pipkin discusses the evaluation and treatment of hip fracture dislocations as defined by the Stewart and Milford classification scheme. He focuses on Grade IV injuries, which at the time lacked an appropriate treatment algorithm.
1,2-Figures A and B show Pipkin IV fractures, due to the presence of an associated acetabular fracture.
3-Figure C shows a Pipkin I fracture, as the fracture is infra-foveal
5-Figure E shows an example of a Pipkin III injury due to the presence of an associated femoral neck fracture.
Droll KP, Broekhuyse H, O'Brien P
J Am Acad Orthop Surg. 2007 Dec;15(12):716-27. PMID: 18063712 (Link to Abstract)
J Bone Joint Surg Am. 1957 Oct;39-A(5):1027-42 passim. PMID: 13475403 (Link to Abstract)
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What Pipkin Classification is this fx?
HPI - 23-year-old male patient admitted to the emergency room s/p high-speed motor vehicle collision. X-rays reveal a femoral head fracture.
How would you treat this comminuted femoral head fracture
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what is the best treatment option?
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What treatment would you choose for this patient?
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No other fractures
How would you classify this femoral head fracture?
HPI - Post MVA 5 days, initially presented with hip dislocation, after reduction hip joint stable
What is the best treatment option?
HPI - Trauma 2 months ago. No treatment
What would be your treatment choice?
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Misdiagnosed hip dislocation, remaining dislocated for 3 days.
After 3 days, the hip was redused under anaesthesia and a capital head fracture occurred
What is the most appropriate treatment at this time?
HPI - Fall from standing height 13.05.2013
What is your surgical treatment?
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how can managed this lady
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What would you do in this case?
HPI - 41 y/o male with irreducible hip dislocation s/p MVA. Outside ED and outside orthopaedic surgeon attempted closed reduction in both the ED and in the OR.
Which approach would you use?
Title: Ideal "Tip - Apex Distance" Author: Michael Archdeacon, MD, MSE Duration:...