An unusual presentation of isolated fracture of femoral head with acetabular rim fracture: ‘A case report’

Femoral head fractures resulting from hip dislocations are rare injuries resulting from high-velocity trauma. Garrett Pipkin, in 1957, classified these fractures into four types. All varieties are associated with hip dislocations, which are attended to as emergencies. Few cases of isolated femoral head fractures without hip dislocation have been published in the literature; we describe one such atypical variant. A 38-year-old male presented with a history of pain and swelling in his right knee following a traffic accident. After 48 hours of bed rest on ambulating, the patient had mild right hip discomfort, but hip examination was essentially normal. Radiology was repeated with plain radiographs and non-contrast computed tomography (NCCT), followed by contrast-enhanced magnetic resonance imaging (MRI) pelvis with bilateral hips. He had a fracture of the head of the femur and acetabular lip with concentric joint. Without hip dislocation, this was an unusual presentation of Pipkin Type IV fracture of the femoral head & posterior acetabular lip. It was managed with open reduction and lag screw fixation of supra-foveal femoral head fracture approaching through the acetabular bony rim avulsion, which was later fixed with lag screw and spring plates. The patient recovered well. This was an unusual presentation of Pipkin type IV fracture without hip dislocation and can be missed due to a subtle presentation, not yet described in the literature. A high degree of suspicion and advanced radiology helped in the appropriate management of the case.