Inter- and Intra-Observer Reliability of the New Comprehensive Classification of Intertrochanteric Fracture of the Femur.

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Abstract

Conflict of interest statement: The authors declare that they have no competing interests. 19. Medicine (Baltimore). 2025 Nov 28;104(48):e45838. doi: 10.1097/MD.0000000000045838. Combined irreducible femoral head fracture-dislocation (Pipkin Ⅳ) and ipsilateral irreducible intertrochanteric fracture: A case report. Chen Z(1), Nie R(2), Zhang W(1), Li L(1), Chen L(1), He W(1), Qu Y(1), Cheng Q(1), Huang J(1), Wu N(1), Jiang J(1). Author information: (1)The Orthopaedics Hospital of Traditional Chinese Medicine, Zhuzhou City, China. (2)Guangxi University of Chinese Medicine, Nanning, China. RATIONALE: Irreducible femoral head fracture-dislocation (FHFD) with concomitant ipsilateral irreducible intertrochanteric fracture significantly increase the difficulty, which undescribed previously. We recorded a surgical strategy for the rare and high-energy injuries, and conducted a follow-up over a period of 4.5 months. PATIENT CONCERNS: A 50-year-old male experienced a motor vehicle collision to the left hip. The assessment by X-ray and 3-dimensional (3D) computed tomography (CT) scan of the left hip confirmed a left posterior hip dislocation with an associated displaced infrafoveal femoral head fracture and a small posterior wall acetabular fracture (Pipkin IV), and an intertrochanteric fracture (Evans-Jensen type II). Both the FHFD and intertrochanteric fracture revealed irreducible characteristics. DIAGNOSES: Pipkin Ⅳ fracture combined with ipsilateral intertrochanteric fracture. INTERVENTIONS: Open reduction and internal fixation was performed via the Kocher-Langenbeck approach, with absorbable screws fixation for the femoral head fracture and proximal femoral nail antirotation for the intertrochanteric fracture. OUTCOMES: In this case, the surgical approach and implant selection achieved satisfactory reduction and stabilization. Follow-up at 4.5 months postsurgery revealed well-healed fractures with no avascular necrosis on hip X-ray, along with good range of motion in the left hip and and the initiation of progressive weight-bearing. LESSONS: For FHFDs demonstrating initial irreducibility, attempted closed reduction requires extreme caution to avoid iatrogenic injury. Furthermore, the current follow-up data suggest this management strategy may offer valuable insights for addressing the rare, complex FHFDs. Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc. DOI: 10.1097/MD.0000000000045838 PMCID: PMC12662404