Arthroscopic osteosynthesis of a Pipkin type IV fracture in a complex polytrauma patient

The Pipkin fracture, a complex injury involving femoral head fractures often accompanied by hip dislocation, presents significant challenges in surgical management. Despite various proposed approaches, the optimal treatment, especially in polytraumatized patients, remains debated. This case report presents a Pipkin type IV fracture treated using a combination of damage control surgery, intramedullary nailing for femoral shaft fractures, and arthroscopic reduction and fixation for the femoral head fracture. A 22-year-old male was admitted following a high-energy car accident, presenting with bilateral femoral shaft fractures, a right Pipkin type IV femoral head fracture with an associated posterior acetabular fragment, and an exposed left patellar fracture. Initial damage control involved external fixation of femoral fractures and irrigation of the patellar wound. Definitive treatment was staged: first, intramedullary nailing of the left femoral shaft and patellar cerclage; second, right femoral shaft intramedullary nailing followed by arthroscopic reduction and fixation of the femoral head fracture. Arthroscopy facilitated minimally invasive removal of intra-articular fragments and secure fixation with a headless cannulated screw. Post-surgical rehabilitation focused on early mobilization and gradual weight-bearing. Using advanced arthroscopic techniques for the fixation of femoral head fracture dislocations resulted in excellent functional outcomes and minimal complications. This case underscores the effectiveness and benefits of arthroscopy in achieving precise reduction and accelerated recovery.