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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)
Droll, JAAOS 2007
J Bone Joint Surg Am. 1957 Oct;39-A(5):1027-42 passim. PMID: 13475403 (Link to Abstract)
PIPKIN, JBJS 1957
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Title: Ideal "Tip - Apex Distance" Author: Michael Archdeacon, MD, MSE Duration:...
HPI - Dashboard injury followed by severe pain, loss of movement in the Lt. Hip and inability to walk.
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
HPI - 21 year male pt , no relevant medical hsitory.
Presented by this bad fracture dislocation thad has been reduced in ER but unstable . What is the best treatment option for this young patient?
what is the best treatment option?
HPI - 47 year old intoxicated male was in a motor vehicle accident when he sustained a right hip dislocation with femoral head fracture. He was initially taken to an outside hospital's Emergency Department for evaluation but then transferred to the treating Level I trauma center.
What treatment would you choose for this patient?
HPI - 19 year female sustained left femoral head fracture.
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?
HPI - Fall from a standing height due to a seizure ( grand mal ) 4 days ago
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?
HPI - A 23 years old lady, with history of Motor Vehicle accident before 2 months ago admitted to the emergency unit at that time with left hip joint dislocation reduction done under general anesthesia but the patient discharged to the home after 4 days on her responsibility, now she is presented with painful limping gait.
how can managed this lady
HPI - admitted 11 days prior s/p MVC. s/p multiple abdominal surgeries and abdomen is still open. CT pelvis on hospital day 11 shown below. Ortho c/s for hip fx/dislocation.
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?