Fractures of femoral head associated with a hip dislocation are relatively rare and often associated with a poor functional outcome. Fractures are characterised by a high risk of avascular necrosis of femoral head, is extremely rare. It is more difficult to treat and has a worse prognosis.
Patient concerns: A 18 year old male with history of sustained injury over his left hip due to jump from running tractor that turned turtle. Pelvic radiograph and 3-D reconstruction computed tomography revealed characteristics of fracture dislocation of femoral head before the elective operation.
Diagnosis: Pipkin type II fracture dislocation of femur head.
Interventions: Firstly, dislocation was corrected by closed manual reduction under anesthesia. Secondly we used lateral approach to fix the femoral head fracture. Then we completed anatomical reduction of fractures with countersunk head screw.
Outcomes: At 4 months follow up the patient could walk and perform activities of daily living without pain, limp, signs of necrosis of femoral head and heterotopic ossification.
Conclusion: Treatment aim should always be the anatomical reduction of fragments with minimal soft tissue injury. Sometimes closed reduction is enough, but in the presence of large fragments, the fracture-dislocation is better treated by ORIF. We should not forget that half of these patients will have good outcomes no matter the treatment strategy. This result depends upon general health of the patient, the severity of the injury, associated cartilage injury, and timing of admission to hospital.
Lessons: Although there are serious complications in Pipkin II fractures early surgical treatment with appropriate approach and fixation could get satisfactory results.