Beyond Pipkin IV: Management of Femoral Head-neck Fracture-dislocation with Posterior Acetabular Wall and Peritrochanteric Fracture in an Adolescent Using a Modified Kocher-Langenbeck Approach.

INTRODUCTION: Femoral head-neck fracture-dislocation with associated posterior acetabular wall and per-trochanteric fractures represents an extremely rare and severe "beyond Pipkin IV" injury pattern. CASE REPORT: A 14-year-old boy sustained posterior hip dislocation with femoral head, neck, acetabular, and trochanteric involvement following a road traffic accident. Emergency open reduction and internal fixation was performed using a modified Kocher-Langenbeck posterior approach with trochanteric flip. RESULTS: Radiological union was achieved by 3 months. At 1-year follow-up, the patient had good hip motion without avascular necrosis or implant failure. CONCLUSION: Early anatomical reconstruction using a posterior approach can produce excellent outcomes in young patients with this rare injury.