Total Hip Arthroplasty in Neglected Acetabular Fracture with Pipkin Type 4 Femoral Head Fracture. A Case Report.

Introduction: Pipkin type 4 fracture is defined as hip dislocation with femoral head fracture and concomitant acetabular rim fracture. These fractures are rare. Neglected fractures develop adaptive changes in the acetabulum, femoral head, and soft tissues around the hip joint, leading to hip arthritis. Total hip arthroplasty is preferred in such cases. After an extensive literature review, we did not find any guidelines for managing neglected Pipkin type 4 fractures. Case Report: A 47-year-old male presented with pain in his left hip and an inability to bear weight on his left lower limb. He had a road traffic accident 1 year ago. On clinical examination, there was a shortening of 3 cm and reduced hip range of motion on 3D computed tomography posterosuperior defect of the acetabular wall along with Pipkin type 4 femoral head fracture was detected. Total hip arthroplasty with acetabular reconstruction using a femoral head autograft was done. At 1 year of follow-up, the patient was pain-free and could walk without any assistance with a normal gait. Conclusion: Uncemented total hip arthroplasty with an autologous structural femoral head graft is a suitable method of treatment for neglected Pipkin type 4 fractures. It preserves bone stock and does not add any financial burden.