Staged Emergency Caesarean Section and Cementless Total Hip Arthroplasty Within a Single Anaesthetic Episode for Pipkin Type III Femoral Head Fracture-Dislocation in a Gravid Patient: A Case Report

Pipkin type III femoral head fracture-dislocation in a gravid patient is an exceptionally rare clinical entity. We report the case of a woman in her early 40s who presented at 36 weeks of gestation following a high-energy motor vehicle collision. Clinical examination and imaging confirmed a left posterior hip dislocation; computed tomography revealed a severely comminuted Pipkin type III fracture that precluded open reduction and internal fixation. A multidisciplinary team formulated a staged single-anaesthetic operative strategy; emergency caesarean section was performed immediately before cementless total hip arthroplasty (THA) within the same anaesthetic episode. A live male neonate was delivered (Apgar scores 3, 6, and 7 at one, five, and 10 minutes). Intraoperatively, the dislocated femoral head was confirmed in direct apposition with the sciatic nerve. THA was completed successfully via a posterolateral approach. Total estimated blood loss was 1,900 mL, requiring transfusion of six units of packed red blood cells. The patient achieved full weight-bearing on postoperative day three and was discharged neurologically intact after eight days. At the three-month follow-up, the Merle d'Aubigné score was 17/18. This case, supported by a focused literature review, demonstrates that a staged same-anaesthetic strategy can achieve favourable maternal and neonatal outcomes in this rare, high-stakes clinical scenario and provides a practical decision-making framework for multidisciplinary teams.