Femoral head fractures i.e. Pipkin fractures are uncommon injuries and there are very few large series in literature with reported outcomes. There remain many controversies regarding diagnosis and management. This study, which is the largest single surgeon experience, is an attempt to get answers to some of these controversies.

This series is an analysis of 51 patients with femoral head fractures. There were 44 males and seven females. The right side was involved in 36 and left in 16 patients. According to Pipkin classification these were 13 Pipkin-I, 27 Pipkin-11, three Pipkin-111 and eight Pipkin-IV fractures. Thirty-two patients were managed by surgical intervention. The surgical approach was posterior in Pipkin-I and in seven cases of Pipkin-II fractures. Another eight Pipkin II cases were managed surgically by anterior Smith-Peterson approach while another eight fractures were accessed by posterior approach with flip osteotomy. The Pipkin III and IV cases were managed using surgical approaches that varied depending on the pattern of associated acetabular injury. The fractured fragment, if small, was excised and, if large, was re-fixed using small fragment partially threaded cancellous screw. Follow-up of two to eight years was available in 39 cases.

Using Thompson and Epstein criteria, 26 patients were rated as having good results, eight fair and five poor results. Early osteoarthritic changes were seen in five patients, avascular necrosis of the femoral head in three patients and one patient had re-fracture in same hip during an epileptic fit with subsequent fixation problems. Of four patients with sciatic nerve injury, two had persisting motor deficit. There was one case of heterotopic ossification.

Most Pipkin-I fractures can be managed by closed reduction, Pipkin-II fractures usually require ORIF. The best results have been obtained by a Smith-Peterson approach if the hip has already been reduced, but posterior approach with flip osteotomy offers the best exposure if the hip is still unreduced. Pipkin III patients need hip replacement if presentation is late, while ORIF gives acceptable outcome in Pipkin IV fractures.

Background and objectives: The antiepileptic drug Phe-nytoin (Diphenyl hydantoin) has been documented to have a beneficial effect on wound healing. Its effect on fracture healing has been investigated to a much lesser extend. In this study we have combined histology, his-tomorphometry and radiology in analyzing the effect of phenytoin on fracture healing, following its local administration.

Methods: Twenty-four Wistar strain rats of 8-9 months age were assigned into two groups of 12 each, which had been matched for age, sex and weight. In one group, selected as the study group phenytoin 20 mg/kg was administered through a 24 gauge needle directly on to the fracture site every 72 hours, while in the controls an equivalent volume of normal saline was administered at the same interval. At 28 days radiographic and histo-logical analysis was done.

Results: Radiographic and histological scoring across the control and test animals did not show any statistical difference. Histomorphometric analysis of the callus however showed that the total periosteal callus on either side of the central bridging callus was mineralized to a greater extend in the phenytoin group animals as compared to the control group animals (p= 0.011).

Conclusion: After analyzing our data, we concluded that phenytoin does have an influence in fracture healing, albeit small, which is primarily on the hard callus region. The hard callus region is the high oxygen tension region and the first region to differentiate. It appears that the effect of phenytoin is probably exerted at the early mesenchymal differentiation stage. However our preliminary work shows that the effect is small and it is not justifiable at this stage to advocate the use of phe-nytoin clinically to augment fracture healing.