Have you seen a case like this?

[shamirortho]

Hey all,

I encountered an unusual case the other night and was wondering if anyone had seen or heard of similar. If not, do you reckon I could get it published as a case report?

I had a 22yr old kid come off a motorcycle and sustain a combination of injuries: Communinuted femoral head fracture dislocation, acetabular posterior wall fracture, AND a neck of femur fracture (all on the same side).
By my reading there is a Pipikin Classification which describes femoral head fractures and goes up to Type IV which then included an acetabular fracture, but to the best of my knowledge there is no further typing to describe the added femoral neck fracture.

If this is extraordinarily rare perhaps a case report of this "type V" etc would be accepted somewhere for case report publication?

[ajq2009]

I had a case as a junior resident similar to this one. It was a high-energy mechanism in a 22 y.o., resulting in ipsilateral fractures of the acetabulum at the posterior wall, femoral neck (displaced), and distal femur that required recon of the articular block. The acetabular fracture frx likely reulted from a dislocation-relocation mechanism, given that this pattern presented in a high-energy mechanism with these associated fractures.

We managed this as an emergent case due to the displaced femoral neck frx in a 22 yo, and took him to the OR immediately after clearance. This was a great case: despite the displaced femoral neck frx posing the more urgent threat in this case (AVN), the femoral neck fracture can't be reduced because the floating fracture won't permit any distal traction that you apply to result in an aligned femoral neck. The reduction, however, can be performed after ex-fixing the distal fracture. As a side note, the pt's extensor mechanism was also disrupted by the trauma and thereafter repaired.

Not sure if it is in the literature, but a great case worth presenting in ms format is you can't find it via lit search. Good luck!

PS: Check your pm later this evening.