Combined irreducible femoral head fracture-dislocation (Pipkin Ⅳ) and ipsilateral irreducible intertrochanteric fracture: A case report

Rationale: Irreducible femoral head fracture-dislocation (FHFD) with concomitant ipsilateral irreducible intertrochanteric fracture significantly increase the difficulty, which undescribed previously. We recorded a surgical strategy for the rare and high-energy injuries, and conducted a follow-up over a period of 4.5 months. Patient concerns: A 50-year-old male experienced a motor vehicle collision to the left hip. The assessment by X-ray and 3-dimensional (3D) computed tomography (CT) scan of the left hip confirmed a left posterior hip dislocation with an associated displaced infrafoveal femoral head fracture and a small posterior wall acetabular fracture (Pipkin IV), and an intertrochanteric fracture (Evans-Jensen type II). Both the FHFD and intertrochanteric fracture revealed irreducible characteristics. Diagnoses: Pipkin Ⅳ fracture combined with ipsilateral intertrochanteric fracture. Interventions: Open reduction and internal fixation was performed via the Kocher-Langenbeck approach, with absorbable screws fixation for the femoral head fracture and proximal femoral nail antirotation for the intertrochanteric fracture. Outcomes: In this case, the surgical approach and implant selection achieved satisfactory reduction and stabilization. Follow-up at 4.5 months postsurgery revealed well-healed fractures with no avascular necrosis on hip X-ray, along with good range of motion in the left hip and and the initiation of progressive weight-bearing. Lessons: For FHFDs demonstrating initial irreducibility, attempted closed reduction requires extreme caution to avoid iatrogenic injury. Furthermore, the current follow-up data suggest this management strategy may offer valuable insights for addressing the rare, complex FHFDs.