Case Report of a Rare Pipkin Type III Femoral Head Fracture.

INTRODUCTION: Femoral head fractures are rare injury compared to other hip pathologies and often associated with posterior hip dislocation. Such fractures are often fraught with complications even after successful surgical fixation. Pipkin described a classification system for such fractures, dividing them into four types, of which Type III (31C.3) fractures are associated with femoral neck fractures. These fractures are the least common and often associated with the worst outcomes. CASE REPORT: We report a rare case of Pipkin Type III fracture after attempted hip relocation and review literature on this topic. A 35-year-old female sustained a right posterior hip dislocation with femoral head fracture following a fall. After attempts of manipulation and reduction, she sustained an iatrogenic right femoral neck fracture resulting in a Pipkin III femoral head fracture. Open reduction and reduction of fracture achieved through headless compression screw of femoral head and cortical screws of femoral neck. Four months after surgery, the patient under osteonecrosis of the femoral head and subsequently required conversion to a right total hip arthroplasty. CONCLUSION: Femoral head fractures have serious sequelae and should be treated with caution. A high index of suspicion is required; hence, if clinically suspicious, proper imaging is paramount to prevent iatrogenic injury to the femoral neck resulting in subsequent avascular necrosis.

Autologous Bone Grafting and Revision Plating in a Case of Persistent High Tibial Osteotomy Non-Union.

INTRODUCTION: Uni-compartmental knee arthritis may be treated with several surgical options including uni-compartmental knee arthroplasty, total knee arthroplasty and high tibial osteotomy. Non-union is a well-established and common complication that may arise from the latter option and few reports have shown successful treatment of persistent non-union of high tibial osteotomy. CASE PRESENTATION: We present a case of persistent non-union after high tibial osteotomy treated with autologous iliac crest bone grafting and revision plating. At 1 year post-operative interval, successful union was achieved after revision internal fixation. In addition, a good functional outcome was achieved. CONCLUSION: In this patient with persistent non-union following high tibial osteotomy, the aim of revision was to restore alignment and effect bone healing while preserving adequate tibial bone stock. Revision plating with autologous bone grafting is a good surgical strategy in the treatment ofpersistent non-union with hardware failure.