Kaveh Gharanizadeh , Mansour Abolghasemian Results Of Surgical Hip Dislocation In Rare Cases Of Irreducible Posterior Hip Dislocation With Pipkin head Fracture Kaveh Gharanizadeh , Mansour Abolghasemian Iran University of Medical Sciences Shafa Hospital, Department of Orthopedic Surgery, Iran University of Medical Sciences, Tehran, Iran Introduction e The classic management of displaced femoral head fractures associated with posterior hip dislocation (Pipkin fracture) is to address the fracture by anterior approach after closed reduction of the hip dislocation(1,2) . Little data exists regarding treatment of irreducible femoral head fracture–dislocations without associated acetabular fracture (1).We evaluated the results of the surgical hip dislocation in these rare cases. fig 1: (e) Early post-op X-Ray. Three years later the radiograph shows some osteoarthritis (f) but the patient is doing well clinically. f Methods Five young males with posterior hip dislocation associated with femoral head fracture (pipkin type 2) but without acetabular fracture were included. After two unsuccessful attempts of closed reduction, all cases underwent open reduction and internal fixation (ORIF) using Ganz technique of surgical hip dislocation. Patients were followed for 35 months (range, 25-41) using Merel D’Aubigne and Postel, thompson and Epstein scores in addition to radiological evaluation. table 1. Patients characteristics and Clinical findings case age (year) operation delay (Hour) fixation device labral repair with suture anchor follow up (month) 1 26 14 mini screw yes 41 2 24 10 mini screw , full threaded pin 2mm no 36 3 34 4 29 8 31 5 38 11 25 Results In all cases we encountered one common pathological feature. Femoral head was buttonholed and locked  through a large capsule-­‐labral flap detached from 12 o’clock posteriorly to the end of the posterior rim of the acetabulum. After reducing the femoral head, the labral flap was repaired using anchor sutures in three cases ( fig 2). Case number 2 had severe comminution of the head that required full access to the head for reconstruction (fig 1). Four cases had congruous reduction without osteoarthritis at the last follow up and all have good to excellent functional scores. . In one case that open reduction was done after 36 hours, osteonecrosis occurred and it was therefore converted to total hip arthroplasty 4 months later. . Conclusion a b table 2. final clinical and radiographic results fig1.Case 2 with severe comminution of the head . Pre-operative X-ray and CT scan indicate the comminuted nature of the fracture. (a,b)).Intraoperatively , a multi-fragmented head fracture was noted (c) that was fixed with threaded pins and mini screws. Note the bleeding from the screw hole(d) case Merel D’Aubigne and Postel thompson and Epstein score AVN heterotopic ossification osteoarthritis (Tonnis grade) revision surgery 1 excellent no grade 1 2 good 3 # poor yes - Hip replacement 4 5 case age operation delay fixation device labral repair fololw up 1 2 3 4 5 Patients characteristics and Clinical findings are summarized in table 1 final results are summarized in table 2 c d # at 4 months hip replacement was done with Good functional result after joint arthroplasty

Kaveh Gharanizadeh , Mansour Abolghasemian Results Of Surgical Hip Dislocation In Rare Cases Of Irreducible Posterior Hip Dislocation With Pipkin head Fracture Kaveh Gharanizadeh , Mansour Abolghasemian Shafa Hospital, Department of Orthopedic Surgery, Iran University of Medical Sciences, Tehran, Iran conclusion fig.2 case 1 with labral repair and excellent results after 41 months. preoperative X-Ray (A), intra operative view of the fracture (B) ,after fixatioin the inferior retinaculum saved to perfuse the fragment ((arrow) (C). labral tear refixed with two anchor sutures (D,E).post op radiography (F). Anterior approach is the classic recommendation for treatment of Pipkin fractures(2,3). However excellent exposure and unlimited access to the joint are the two prerequisites for optimal surgical reconstruction(4). We believe that repair of labral injuries and addressing comminuted fractures of the head could only be performed with a surgical dislocation approach, taking advantage of the safe and versatile access it provides to the acetabulum and femoral head. A B Lig.teres A References c D Samir Mehta, et all . J Orthop Trauma Volume 22, 2008 James R. Ross , et all. Curr Rev Musculoskelet Med (2012) P.V. Giannoudis ,et all . Injury, Int. J. Care Injured 40 (2009) Philipp Henle,et all . Injury, Int. J. Care Injured (2007) weitbrecht ligament  Correspondence Kaveh Gharanizadeh, MD, Assistant Professor of Orthopedic Surgery, Shafa Hospital, Iran University of Medical Sciences, Tehran, Iran Email: kavehgharani@gmail.com E F