[Combination injuries of the hip joint including shear fractures of the femoral head].

Shear fractures of the femoral head always occur in association with a dislocation of the hip. In most cases there is a posterior dislocation with a fracture of the inferior aspect of the head. Treatement and long-term results of 23 personal observations are reported. These are, according to Pipkin's classification, divided into six Type-1, four Type-2, five Type-3 and eight Type-4 fracture-dislocations. The poorest results were found in the group of Type-4 injuries, which included six cases of avascular necrosis of the femoral head. In all of these six cases, the femoral head was reduced no sooner than three days after the accident. Specific recommendations for the treatment of Pipkin's four types of combined injuries are made, taking into consideration fragment size, grade of dislocation, and age of the patient.