Functional Outcome of Pipkin Type III Fracture Managed by Osteosynthesis through Trochanteric Flip Osteotomy in a Young Patient after 5 Years Follow-Up - A Case Report and Literature Review.

INTRODUCTION: Femoral head fractures are uncommon. A femoral head fracture associated with an ipsilateral neck of femur fracture is classified as a Pipkin's Type III fracture and is exceedingly rare. It is a high-energy injury associated with an extremely poor prognosis. This has led some authors to advocate primary arthroplasty for these injuries. The aim of reporting this case is that in young patients even with severely displaced Pipkin's Type III injuries, it is reasonable to opt for internal fixation of these fractures. It is possible to obtain good function for a significant amount of time as evidenced by the 5-year follow-up in this case.

CASE REPORT: A 25-year-old male presented 4 days after a motorbike accident. He was diagnosed as a femoral head fracture with neck fracture of the left side. This fracture is classified as type III Pipkin fracture or OTA type 31C.3. This case was managed with open reduction and internal fixation utilizing the trochanteric flip osteotomy and multiple screws. It is worth to report the first case of Pipkin type three fracture having satisfactory functional outcome after 5 years of follow-up.

CONCLUSION: It is worth preserving the femoral head in young patients. Good pre-operative planning, meticulous reduction, tissue handling, and fixation could get satisfactory results. The outcome also depends on post-operative rehabilitation and compliance of patient.