Date: Thu, 8 Jul 2004 03:12:27 +0200
From: Josep M. Muñoz Vives
Subject: Pipkin fracture
This 25 yo old man suffered a MVA with:
Once reduced the dislocation we obtained a CT which demonstrates this head impaction fracture (31-C2.?) with loose bodies.
I'm concerned about the fact that the head seems depressed, not truly broken and the fragments don't match exactly the defect created, but at the same time there seems to be no fracture of the acetabulum which I carefully reviewed on the CT. Anyone could explain this? Do you think the fragments come from the head and they are rotated?
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Which would be your treatment of choice?
Thanks
Dr. Josep M. Muñoz Vives
Orthopedic Dept.
Hospital Universitari Dr. Josep Trueta.
Girona
Catalunya, Spain
Date: Thu, 8 Jul 2004 09:32:24 -0400
From: James Carr
It appears to be fragments from the posterior superior femoral head, and is analogous to a Hill Sachs lesion of the humerus. The fragments appear on the same cuts as the lesser trochanter, therefore my assessment of the location- this could be confirmed by the cuts in other planes. I think they are rotated, so therefore do not appear to match the defect. Also, some depression of the femoral head has occurred. The treatment is surgical, with ORIF if the fragments will accept minifragment screws countersunk in the femoral head. Excision is required if they are too fragmented to fix. A hip scope could be done if you are so inclined. I would use the Synthes Modular hand set, and use either 2.4 or 2.0 screws. You will need a minifragment set that has extra long screws. I have included some pics from a case we did yesterday of a femoral head fracture with a piece flipped 180 in the joint (bigger piece than yours). We used a medial approach, and 2.4 mm screws.
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Jim Carr
James B. Carr, MD
Premier Orthopedic Specialists
Columbia, SC