ABSTRACT
Fractures of the femoral head (Pipkin fractures) are relatively uncommon. In cases of immediate, gentle reposition and considerate soft tissue treatment during operative treatment, Pipkin 1 and 2fractures can heal with good long-term results. However, some long-term problems regularly occur. Conservative therapy is possible in cases of anatomic articulation or the presence of only very small fragments that do not compromise articulation after closed reduction. Differentiated indications for conservative treatment in Pipkin 1 and Pipkin 2 fractures can result in a better outcome than operative treatment. All other fractures should be treated operatively. The approach has to be adapted to fragment size and location. Small fragments in Pipkin 1 fractures can simply be removed, but larger fragments in Pipkin 1 and Pipkin 2 fractures should be fixed, preferably via an anterior approach. Pipkin 3 fractures generally require total hip arthroplasty. Pipkin 4 fractures have a relatively poor outcome. The strategy of treatment depends on the necessity of operative fixation of the acetabular fracture and the size of the femoral fragment. The anterior approach is preferred in cases of stable joint situations with only a small acetabular rim fragment, and in cases of instability the dorsal approach is preferred. Surgical luxation can be advantageous for the treatment of Pipkin 4 fractures.
Subject(s)
Femur Head/injuries , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Acetabulum/diagnostic imaging , Acetabulum/injuries , Acetabulum/surgery , Adolescent , Adult , Arthroplasty, Replacement, Hip/methods , Bone Screws , Female , Femur Head/diagnostic imaging , Femur Head/surgery , Follow-Up Studies , Fracture Healing/physiology , Fractures, Bone/classification , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Fractures, Comminuted/classification , Fractures, Comminuted/diagnostic imaging , Fractures, Comminuted/surgery , Hip Fractures/classification , Hip Fractures/diagnostic imaging , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Male , Middle Aged , Multiple Trauma/diagnostic imaging , Multiple Trauma/surgery , Postoperative Complications/diagnostic imaging , Radiography , Young AdultABSTRACT
For the hemodynamically unstable patient with pelvic fracture a target focussed and rapid diagnostic and therapy is mandatory. After hemorrhage control at crash site the direct transport in a trauma center follows. Primary therapy in the emergency room sometimes includes stabilization by a pelvic clamp or an external fixator. If the patient is still hemodynamically unstable the life threatening bleeding is packed. After that simple internal osteosynthesis is allowed. The presented article shows the possible options of the therapy. The main message is: hemorrhage control is not possible without stabilization of the pelvic ring.
