Abstract
BackgroundFemoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center.Materials and methodsA retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis.ResultsWe identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision.ConclusionsFractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon.Level of evidenceIV—prognostic.
Highlights
The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center
We hypothesized that using a standard protocol for management, surgical approach and fixation of femoral head fractures would result in low rates of fixation failure, heterotopic ossification (HO) and avascular necrosis (AVN)
Of 69 femoral head fractures, 62 (89%) with follow up equal or greater than 6 months had uncomplicated outcomes (Table 2): 42 (60%) patients in this group were managed with operative reduction and internal fixation (ORIF), 18 (26%) were treated with fragment excision, 8 patients were treated non-operatively and 1 patient was managed with primary hemiarthroplasty
Summary
Fractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. AVN and posttraumatic degenerative disease of the hip occur but are uncommon. They are often the result of high-energy trauma to the hip or lower extremity, and commonly associated with a hip dislocation. J Orthop Traumatol (2017) 18:235–241 consecutive series of patients treated for this uncommon injury
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
