Femoral Head Fractures Revisited

Abstract

Background: Femoral head fractures have long been associated with a poor outcome. To date, only a few large series have adequate follow-up, and the description of injury types, treatment and outcome are often incomplete and thereby preclude comparison. Here, we retrospectively review our results with the treatment of a large series of femoral head injuries associated with posterior hip dislocations. Patients and Methods: A retrospective review of posterior hip dislocations with femoral head fractures was done. Fractures were classified according to Pipkin, Brumback and to the AO classification. Outcome was based on physical and radiographic evaluation, in addition to the Merle d'Aubigne & Postel and the Thompson & Epstein scores. Results: 33 femoral head fractures with posterior hip dislocations were treated at our institutions between 1970 and 1999. Nonoperative treatment was chosen in seven cases, open reduction and internal fixation (ORIF) in 20, and fragment excision in six. Average follow-up was 64 months (range 24–252 months). Of these, 56% had an excellent/good result, 16% did fair, and 28% had a poor outcome. Pipkin II fractures (Brumback 2A) did better than the Pipkin I (Brumback 1A) fractures, whereas the poorest outcome was seen in the Pipkin IV (Brumback 1B and 2B) fractures. There were four presurgical nerve lesions that were sequelae of the injury. Complications included heterotopic ossification (21%), deep infection (3%), avascular necrosis (6%), and recurrent dislocation (6%). Conclusions: Posterior hip dislocations with femoral head fracture-dislocations represent severe injuries. Better visualization and ability to internally fix these fractures could potentially improve the outcome. We introduce a modified, anterolateral approach to femoral head fractures based on a digastric trochanteric osteotomy.