Salvaging Femur Head in a Pipkin Type III Femoral Head Fracture with Open Reduction and Internal Fixation Using Herbert Screw Fixation: A Rare Case Report

Introduction: Pipkin Type III femoral head fractures, characterized by dislocation and concurrent fractures of the femoral head-and-neck, present significant challenges due to the risk of avascular necrosis (AVN) and post-traumatic osteoarthritis. Open reduction and internal fixation (ORIF) using surgical hip dislocation with trochanteric flip osteotomy has been proposed as a viable option, enabling optimal exposure of the femoral head and acetabulum while potentially minimizing complications. Case Report: We report a case of a 40-year-old male presenting with a right hip dislocation and a Pipkin Type III femoral head-and-neck fracture. ORIF was performed with a surgical hip dislocation and trochanteric flip osteotomy, followed by fixation using 3.5 mm Herbert screws. Post-operative rehabilitation involved immediate early range of motion exercises, with delayed weight-bearing initiated at 6–8 weeks. Radiographs at regular intervals of 6, 12, 18 and 24 months showed no signs of AVN or arthritis, with gradual onset osteoarthritic changes appearing from 2.5-years post-operative. Conclusion: This case underscores the efficacy of ORIF with trochanteric flip osteotomy for Pipkin Type III fractures, offering functional outcomes comparable to other methods. This technique is associated with higher heterotopic ossification rates but may reduce the risk of AVN, early-onset arthritis relative to alternative methods and delay in requirement of hip replacement surgery. Despite a mild-to-moderate progression of osteoarthritis by the 3rd year of follow-up, the patient reported minimal hip pain until this time, highlighting the durability of this approach. Keywords: Pipkin type III fracture, femoral head fracture, trochanteric flip osteotomy, avascular necrosis, hip dislocation, osteoarthritis.