Case of the Month – Hip Injury – Part 2 Now Live


The surgeon immediately recognized that Spc Walsh had a closed left hip fracture dislocation and without delay attempted a manual closed reduction. Unfortunately, this was not successful, even with the patient under anesthesia. The surgeon then attempted another closed reduction, this time with a Steinmann pin placed in the proximal femur. The fracture, however, was found to be irreducible.

The surgeon decided to perform an open reduction with internal fixation of the Pipkin 2 femoral head fracture.

figure 5

The patient was then transported by aeromedical evacuation back to his home country where he reportedly went on to complete his healing and recovery without significant complication.

2 thoughts on “Case of the Month – Hip Injury – Part 2 Now Live”

  1. Ok, very interesting case. So, in austere conditions, if closed reducution is not possible, one should do an open reducution, as a fracture is highly probable. Which surgical approach would be advised, when a scanner is not available?
    Operative Versus Nonoperative Management of Pipkin Type-II Fractures Associated With Posterior Hip Dislocation
    These authors recommend a Smith-Peterson approach. Any suggestions?

  2. Rene,
    Thanks for your comments. Sorry my response is a bit delayed. The main reason for open reduction is to achieve the reduction…not necessarily to operate on the fracture. As you know, conservative treatment of many pipkin femoral head fractures can be better than operative results. The issue would be if the fracture is displaced and above the fovea. In most of these cases the Smith-Peterson approach is recommended due to the lower likelihood of avascular necrosis due to further compromise of femoral head circulation due to the surgical approach in addition to the compromise caused by the trauma of the fracture +/- dislocation.
    Often, if the surgeon in an austere setting is the only orthopaedic surgeon and is unfamiliar with that approach, then of course he or she should use the approach that they can most safely accomplish to achieve reduction of the dislocated hip.

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