INTERMEDIATE-TERM EXPERIENCE OF PIPKIN FRACTURE-DISLOCATIONS OF THE HIP

The purpose of this study was to review our intermediate-term experien ce with posterior fracture-dislocations of the hip. We evaluated the a ccuracy of the Pipkin and Brumback classification schemes as predictor s of outcome, assessed the importance of certain treatment variables, and determined the complication rates of this injury in a group of 33 patients followed for an average of 49 months. The overall results wer e 67% good, 18% fair, and 15% poor, with no excellent results. The Pip kin classification scheme was a useful predictor of outcome because pa tients with less severe Pipkin 1 or 2 injuries had statistically signi ficant better outcomes than did those who sustained Pipkin 3 or 4 inju ries (p < 0.02). Due to a large number of subgroups, we could not demo nstrate the usefulness of the Brumback classification system as a pred ictor of outcome. There were no statistically significant differences in outcome or complication rates when comparing time with hip reductio n, definitive operative intervention, or anatomic operative approach t o injury. Our study represents the second largest report on posterior dislocation of the hip associated with femoral head fracture. Although outcome of the patients in our series is not outstanding, the 67% goo d results represent a significant improvement over all previous report s with large numbers of patients. We demonstrate significant improveme nt in prognosis when treatment goals for these injuries include anatom ic reduction, restoration of hip joint stability, and removal of all i nterposed bone fragments.