Medical Microbiology Reports

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Terrible triad of the hip

Pipkin-III femoral head fracture dislocation is a rare injury and its outcome is guarded. Some authors believe that femoral neck fracture of Pipkin- III injury is largely iatrogenic. Recent literature showed that none of these injuries had excellent outcome, and most patients end up with hip replacement. We present a case of 34-year-old man who sustained a traumatic right hip injury with fracture-dislocation and an iatrogenic femoral neck fracture during closed reduction of the hip dislocation. A modified Gibson approach was performed to reduce and fix the femoral head and neck fractures in a retrograde fashion. Follow-up at 26 months assessment showed viable femoral head, and excellent functional outcome. Iatrogenic femoral neck fracture in the setting of femoral head dislocation is not uncommon. Clinical and radiological signs of irreducible dislocation can be subtle and easily missed which might lead to devastating complications like iatrogenic femoral neck fracture. Recognition of this unique injury, timely intervention, and meticulous dissection might positively alter the patient’s outcome. This is the first case report in the orthopedic literature with long follow up that showed excellent functional outcome. We have termed this condition “terrible triad of the hip” as it represents a devastating injury which includes femoral head fracture, femoral hneck fracture and hip[ dislocation. This case serves to enlighten orthopedists about the risk of iatrogenic femoral neck fracture, methods to avoid such complication, and the proper management.

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