- See:
Posterior Frx Dislocations of the Hip
- Discussion:
- prognostic features:
- long term results are proportional to the degree of intial trauma
- this explains percentage of good results progressively decreasing from type II to type V injuries.
- reduction, either closed or open, should be performed within 12 to 24 hrs to ensure the best results.
- if
closed reduction is selected, it should be attempted only once;
- if this fails, one should proceed to an open reduction to prevent further damage to the femoral head.
- w/ type IV fractures (of the acetabular floor)
- pts w/ displaced frx of acetabular dome have uniformily poor results regardless of treatment;
- thompson / epstein classification:
-
type I: w/ or w/o a minor fracture
- type II: w/ large single frx of post. acetabular rim;
- type III: w/ comminution of rim of acetubulum w/ or w/o major frag;
- type IV: w/ a fracture of the acetabular floor
- type V: w/ a fracture of the femoral head;
-
Operative Versus Nonoperative Management of Pipkin Type-II Fractures Associated With Posterior Hip Dislocation
-
Arthroscopic Treatment of Pipkin Type I Femoral Head Fractures: A Report of 2 Cases
- associated Injuries:
- Pre-Reduction Radiographs:
-
pelvic series radiographs (
AP,
inlet and outlet);
-
acetabular series radiographs (
Judet views);
- radiograph of the femur and knee;
- Management:
- attempt
closed reduction unless:
- bone fragment is noted in the acetabulum:
- it is essential to determine whether the hip is stable following reduction by stress testing;
- stress testing is especially important if
posterior wall frx is present;
- type II frx of significant size may be treated non operatively if there is no posterior hip instability;
- unstable reduction:
- hip redislocates w/ 90 deg flexion;
- frx of the femoral head prevents the reduction
- comminuted frx of acetabulum, esp.
posterior wall frx;
- Open Reduction of Posterior Fracture Dislocations:
- thompson-epstein type IV
- w/ type IV frx, primarily
closed reduction is performed, followed by careful x-ray evaluation of the associatted acetabular frx;
- decesion for open reduction of acetabular frx is similar as for
central fracture dislocations;
- one must remember that frxs communicating w/ the
greater sciatic notch have the potential to damage the superior
gluteal artery;
- life threatening
blood loss can occur once the tamponade effect of fracture is removed at the fracture reduction;
- abdominal approach of the hypogastric artery may be required;
- thompson-epstein type V - posterior fracture dislocations:
- there is an assoicatted fracture of the femoral head;
- subclassified according to Pipkin;
- subtype I: posterior dislocation of the hip w/ fracture of the femoral head cauded to the fovea centralis;
- subtype II: posterior dislocation of the hip w/ fracture of the femoral head cephalad to the fovea centralis;
- subtype III: type I or type II with assoc. frx of femoral neck
- subtype IV: type I, II, or, III w/ assoc. frx of acetabulum;
Biomechanical consequences of fracture and repair of the posterior wall of the acetabulum.
Computed tomography evaluation of stability in posterior fracture dislocation of the hip.
Stability of posterior fracture-dislocation of the hip. Quantitative assessement using computed tomography.
Reduction of posterior dislocation of the hip in the prone position.
Operative Management of Displaced Femoral Head Fractures: Case Matched Comparison of Anterior versus Posterior Approaches for Pipkin I and Pipkin II Fractures.
Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis.
Functional outcome of patients with femoral head fractures associated with hip dislocations.
