Pipkin type I femoral head fracture managed by safe surgical dislocation through Gibson’s interval with Ganz trochanteric osteotomy: a case report

Authors

  • Rahul Puranik Department of Orthopaedics, B. J. Government Medical College, Pune, Maharashtra, India https://orcid.org/0000-0003-0638-7165
  • Shreyas Zad Department of Orthopaedics, Govt. Medical College, Nagpur, Maharashtra, India https://orcid.org/0009-0000-0370-7173
  • Sandeep Deshpande Department of Orthopaedics, BDBA Hospital, Mumbai, Maharashtra, India
  • Sayali Kengar Department of Orthopaedics, YCM Hospital, Pune, Maharashtra, India
  • Vaibhav Sapkal Department of Orthopaedics, B. J. Government Medical College, Pune, Maharashtra, India
  • Aditya Sawant Department of Orthopaedics, B. J. Government Medical College, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261235

Keywords:

Pipkin type I, Femoral head fracture, Posterior hip dislocation, Safe surgical dislocation, Ganz osteotomy

Abstract

Femoral head fractures concurrent with posterior hip dislocations are rare and complex injuries that challenge conventional surgical exposure and fixation. This case significantly advances our knowledge for management of femoral head fractures. A 47-year-old male driver sustained a dashboard injury resulting in a posterior right hip dislocation, which was closed reduced at a local hospital. Imaging at our tertiary center confirmed a Pipkin type I femoral head fracture involving over 20% of the head. He underwent safe surgical dislocation through Gibson’s interval using the Ganz trochanteric flip osteotomy; the fragment was anatomically reduced with three 3.5‑mm headless cannulated screws, and the osteotomy was fixed using 6.5-mm cannulated screws. The Ganz approach facilitates anatomic exposure and fixation while preserving femoral head vascularity, making it a robust surgical method for such uncommon but technically demanding cases.

References

Birkett J. Description of a case of dislocation of the hip with fracture of the head of the femur. Med Chir Trans. 1869;52:133-4.

Pipkin G. Treatment of Grade IV fracture-dislocation of the hip. J Bone Joint Surg Am. 1957;39:1027-42.

Epstein HC. Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Joint Surg Am. 1974;56:1103-27.

Brumback RJ, Kenzora JE. Fractures of the femoral head. Instr Course Lect. 1988;37:309-30.

Giannoudis PV, Pape HC, Roberts C. Management and clinical results of femoral head fractures. Injury. 2009;40:1245-51.

Scolaro JA, Marecek GS, Firoozabadi R, Krieg JC. Management and radiographic outcomes of femoral head fractures. J Orthop Traumatol. 2017;18:235-41.

Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip. J Bone Joint Surg Br. 2001;83-B(8):1119-24.

Masse A, Aprato A, Rollero L, Campacci A, Ganz R. Surgical hip dislocation is a reliable approach for treatment of femoral head fractures. Clin Orthop Relat Res. 2015;473:3744-51.

Wang J, Li J, Xu C, Xu Y. 3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis. J Orthop Surg Res. 2019;14:338.

Engel JL, Slongo T, Bastian JD. Pipkin type IV femoral head fractures: A case series and review of literature. Eur J Orthop Surg Traumatol. 2021;31:791-5.

Bettinelli A, Grappiolo G, Aprato A. Meta-analysis of outcomes of surgical dislocation versus conventional approaches in femoral head fractures. Hip Int. 2019;29(3):245-53.

Henle P, Kloen P, Siebenrock KA. Femoral head injuries: Which treatment strategy can be recommended? Injury. 2007;38:478-88.

Swiontkowski MF, Thorpe M, Seiler JG, Hansen ST. Operative management of dislocated femoral head fractures: Case-matched comparison of anterior vs posterior approaches. J Orthop Trauma. 1992;6(4):437-42.

Tsai SHL, Tai WC, Fu TS, Tischler EH, Rahman R, Lim YK, et al. Does Surgical Repair Benefit Pipkin Type I Femoral Head Fractures? A Systematic Review and Meta-Analysis. Life (Basel). 2022;12(1):71.

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Published

2026-04-27

How to Cite

Puranik, R., Zad, S., Deshpande, S., Kengar, S., Sapkal, V., & Sawant, A. (2026). Pipkin type I femoral head fracture managed by safe surgical dislocation through Gibson’s interval with Ganz trochanteric osteotomy: a case report. International Journal of Research in Orthopaedics, 12(3), 805–808. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261235

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Section

Case Reports