Pipkin's 1957 case series of 25 hips establishes a four-type subclassification of Grade IV hip fracture-dislocation — dislocation combined with femoral head or neck fracture. The classification is based on fracture location relative to the fovea capitis and the presence of associated femoral neck or acetabular rim fractures. The paper analyzes functional outcomes by treatment approach across follow-up periods of 1 to 18 years.
Every hip fracture-dislocation you see in the trauma bay needs to be classified by Pipkin type before you decide on treatment — and that decision tree starts at the fovea capitis. For Types 1 and 2, the data are clear: attempt closed reduction urgently. Pipkin demonstrated bone union in every case reduced promptly and immobilized. Delay costs the patient their hip.
For Type 1 with a small fragment that blocks reduction, excision is acceptable. For Type 2, the large cephalad fragment involves the weight-bearing surface. Excision creates incongruity and accelerates arthritis, so internal fixation or reduction should be attempted first.
Type 3 (plus femoral neck fracture) requires open reduction and neck fixation to reduce the problem to a Type 1 or 2. Type 4 (plus acetabular rim fracture) requires acetabular stability to be restored if the rim fragment compromises the reduction.
The one technique pearl worth memorizing: use Stimson's gravitational method for closed reduction. Levering against the iliac rim with a weakened femoral neck is how you turn a Pipkin fracture into a Type 3.
Pipkin's 1957 case series of 25 hips establishes a four-type subclassification of Grade IV hip fracture-dislocation — dislocation combined with femoral head or neck fracture. The classification is based on fracture location relative to the fovea capitis and the presence of associated femoral neck or acetabular rim fractures. The paper analyzes functional outcomes by treatment approach across follow-up periods of 1 to 18 years.
Every hip fracture-dislocation you see in the trauma bay needs to be classified by Pipkin type before you decide on treatment — and that decision tree starts at the fovea capitis. For Types 1 and 2, the data are clear: attempt closed reduction urgently. Pipkin demonstrated bone union in every case reduced promptly and immobilized. Delay costs the patient their hip.
For Type 1 with a small fragment that blocks reduction, excision is acceptable. For Type 2, the large cephalad fragment involves the weight-bearing surface. Excision creates incongruity and accelerates arthritis, so internal fixation or reduction should be attempted first.
Type 3 (plus femoral neck fracture) requires open reduction and neck fixation to reduce the problem to a Type 1 or 2. Type 4 (plus acetabular rim fracture) requires acetabular stability to be restored if the rim fragment compromises the reduction.
The one technique pearl worth memorizing: use Stimson's gravitational method for closed reduction. Levering against the iliac rim with a weakened femoral neck is how you turn a Pipkin fracture into a Type 3.