Anterior periosteal flap elevation to aid reduction and reduce retinacular tension in Pipkin I/II femoral head fractures

BACKGROUND: Pipkin I/II type femoral head fractures are rare injuries in which it can be difficult to achieve stable anatomical reduction of the inferomedial fragment. In some cases, the medial synovial fold and the medial retinaculum act as soft tissue tensor, limiting the mobilisation of the fragments and increasing the risk of vascular injury during reduction. OBJECTIVES: This technical note describes a periosteal flap manoeuvre designed to release tension on the medial retinaculum while preserving its vascular contribution, thereby facilitating controlled reduction of inferomedial fragments in Pipkin I/II fractures. CONCLUSION: The technique described allows for safe mobilisation of the retinaculum complex and effortless reduction of the fragment without aggressive dissection. This manoeuvre may be a useful adjunct when standard reduction methods fail.