Posterior wall acetabulum fracture-dislocation with subsequent ipsilateral pipkin IV fracture-dislocation: How many hits can a hip take?

The treatment of acetabulum fractures is a technically-demanding task for orthopaedic trauma surgeons. The treatment of femoral head fractures associated with acetabulum fractures, pipkin IV fractures, presents difficulty as usually the femoral head fracture requires treatment through an anterior approach and the acetabulum fracture, which is commonly a posterior wall fracture, requires treatment through a posterior approach. Recently, surgical dislocation of the hip has become an accepted option for treatment of these fractures as it allows treatment of the femoral head fracture and posterior wall acetabulum fracture through one approach. However, dual anterior and posterior approaches are acceptable. We present 15 year follow up of an 18 year old female who underwent open reduction internal fixation of a posterior wall acetabulum fracture through a Kocher-Langenbeck approach. Four months later the patient sustained a second fracture dislocation of the same hip, this time a femoral head fracture with an associated posterior wall acetabulum fracture that was treated with a Kocher-Langenbeck approach for the revision acetabulum and a approach for the femoral head fracture. At fifteen years the patient had a Merle d'Aubigne score of 15 and a Harris hip score of 71. She was gainfully employed and subjectively happy with her surgical result. While treatment of pipkin IV fracture dislocations can be treated through a surgical dislocation of the hip, dual surgical approaches are a viable option in certain cases.