Fig. 4.

Algorithm for surgical approaches. For Pipkin type I and II fractures, the anteromedial Smith-Peterson approach represents the preferred surgical exposure. For Pipkin III fractures the Smith-Peterson and the anterolateral Watson-Jones approach is recommended. Pipkin IV injuries with concomitant acetabular fractures of the anterior column should be addressed using the Stoppa approach with Smith-Peterson extension. Pipkin IV fractures with injuries of the posterior column or posterior fragment dislocation should be treated with the Kocher-Langenbeck approach or the modified Gibson approach in combination with trochanter osteotomy.