The Journal of Bone and Joint Surgery, Vol 70, Issue 2 233-239, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both
K Hougaard and PB Thomsen
Department of Orthopaedic Surgery, Odense University Hospital, Denmark.
To determine the prognosis and best treatment for patients who have a
posterior dislocation of the hip associated with a fracture of the femoral
head or neck (Grade IV, according to the classification of Stewart and
Milford), we surveyed the records of 201 patients who had been treated for
203 posterior dislocations from 1958 to 1985 and selected the cases of 19
patients (19 posterior fracture-dislocations of the hip) for further
review. Each of the injuries had resulted from a motor-vehicle accident.
Thirteen patients had had a posterior dislocation with an associated
fracture of the femoral head located either caudad or cephalad to the fovea
centralis (Pipkin Type-I or Type-II injury), one had had a posterior
dislocation with associated fractures of the femoral head and neck (Pipkin
Type III), two had had a posterior dislocation with associated fractures of
the femoral head and the acetabular rim (Pipkin Type IV), and three had had
a fracture-dislocation that we could not categorize according to the Pipkin
classification. Twelve patients had been treated by closed reduction for a
Type-I or Type-II injury; one, by open reduction after an unsuccessful
closed reduction for a Type-I injury; one, by primary total hip replacement
for a Type-III injury; and three, by open reduction with screw fixation of
the acetabular fracture and removal of the fragment of the head for two
Type-IV injuries and one unclassified injury. An additional two patients
had had both a fracture of the femoral neck and a dislocation; one hip was
treated primarily with a Moore prosthesis and the other was left
unreduced.(ABSTRACT TRUNCATED AT 250 WORDS)
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