Fig. 3.

Treatment algorithm according to the Pipkin classification. In Pipkin type I and type II fractures, the treatment depends on the degree of displacement after closed reduction. For fractures with a displacement of less than 1 mm a non-operative approach should be considered. Fractures with a displacement of more than 1 mm should be addressed with open reduction and internal fixation (ORIF) or fragment removal. In Pipkin type III fractures, surgical treatment depends on signs of arthritis in the hip joint and the physical demands of the patient. If advanced signs of arthritis or immobilization are evident, a bipolar endoprosthesis or total hip arthroplasty are advised. If not, ORIF with surgical hip dislocation is suggested, attempting to preserve the femoral head, especially in younger patients. In Pipkin type IV fractures with non-displaced and small fracture segments, a non-operative approach with weight-bearing of the hip joint is recommended. Displaced and large fracture segments are usually treated with ORIF by the Kocher-Langenbeck approach with or without trochanteric-flip osteotomy.