The optimal surgical approach for combined femoral head and acetabular fractures (Pipkin IV) is controversial because of their
rarity and lack of definitive reports. Surgical dislocation with trochanteric flip osteotomy (TFO) allows simultaneous exposure
of the acetabulum and femoral head. We protected the obturator internus and inferior capsule during repair with a heavy suture
at the inferior extent of the traumatic capsulotomy. We retrospectively reviewed 12 patients with Pipkin IV fractures treated
using this approach during a 6-year period. The minimum followup was 24 months (mean, 47 months; range, 24–71 months). Clinical
outcomes were measured using the Merle d’Aubigné-Postel and Thompson-Epstein scoring scales. Radiographically, all patients
achieved healing of their acetabular fractures; 11 achieved healing of the femoral head fracture and osteonecrosis developed
in one patient. The average Merle d’Aubigné-Postel score was 15.6 of 18; using the Thompson-Epstein score, 10 of the 12 patients
had good or excellent outcomes, one had a fair outcome, and one had a poor outcome. Trochanteric flip osteotomy allowed for
simultaneous exposure and repair of both lesions in Pipkin IV fractures. Using a uniform surgical protocol with TFO rendered
clinical results comparable to previously reported outcomes in series of isolated femoral head fractures.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.