Femoral Head Fracture-dislocation Research Articles

Using an Intraoperative Stress Exam to Direct Treatment in Posterior Femoral Head Fracture-Dislocations.

To examine the results of a treatment algorithm incorporating an EUA performed intraoperatively after fixation of the femoral head through a Smith Petersen approach to determine need for posterior wall or capsule repair. Design: Retrospective review. Two Level 1 trauma centers. All acute, traumatic femoral head fractures from posterior hip dislocations treated at participating centers over a 5-year period from 2017-2022. Injuries were classified according to the Pipkin system. The primary outcome was the result of intraoperative EUA performed after femoral head fixation to determine the need for Kocher-Langenbeck exposure for posterior wall and/or capsule fixation. The secondary outcomes included rates of avascular necrosis, heterotopic bone formation, late instability, and conversion to total hip arthroplasty. Studied were 63 males and 22 females with mean age 32.5 (range 18-71). 79 of 85 (92.9%) patients had a stable EUA after fixation of the femoral head through a Smith-Petersen approach. Six (6/85, 7.1%) underwent an additional Kocher-Langenbeck approach for posterior wall or capsule fixation. This included 1 Pipkin I, 1 Pipkin II, and 4 Pipkin IV injuries. Of the Pipkin IV injuries, 51/55 (92.7%) had stable EUA and did not require fixation of their posterior wall. This included 7 patients with wall involvement >20%. Five patients were excluded because of planned fixation of their posterior wall based on preoperative imaging. Of patients with at least 6 months follow up, 16 of 65 (26.4%) developed radiographic evidence of AVN and 21 of 65 (32.3%) evidence of heterotopic bone formation. Seven out of 65 (10.8%) were converted to total hip arthroplasty over the study period. When comparing patients with a single exposure with those with additional KL exposure, they did not vary in their rate of AVN (27.1% vs. 0.0%, P=0.3228), HO formation (30.5% vs. 50.0%, P=0.3788), or conversion to total hip arthroplasty (10.2% vs. 16.7%, P=0.510). This study found residual posterior hip instability after femoral head fixation in patients with and without posterior wall fractures after posterior dislocations. The results of this study support use of an EUA after femoral head fixation to identify residual posterior hip instability in all femoral head fractures from posterior hip dislocations, regardless of Pipkin type. Use of the Smith-Petersen exposure remains a viable surgical option and may be improved with incorporation of an EUA after femoral head fixation. For Pipkin IV injuries with posterior wall fractures with indeterminate stability, an EUA accurately identifies residual instability. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Combined Irreducible Femoral Head Fracture-Dislocation and Ipsilateral Segmental Femur Fracture: A Case Report.

A 48-year-old man presented to a Level 1 trauma center after a motor vehicle crash with a right irreducible posterior hip dislocation and ipsilateral fractures of the femoral head and segmental femur shaft. This injury was managed with open reduction and internal fixation and antegrade intramedullary nailing. This is the first report of a combined irreducible femoral head fracture-dislocation and a segmental femur fracture, a rare injury that requires a stepwise approach to operative management of each injury. Surgeons must recognize the clinical and radiographic findings associated with irreducible hip dislocations in the setting of ipsilateral fractures to the femoral head and shaft.

Characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations

To summarize the characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. The clinical data of 4 patients with irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations between January 2010 and December 2019 were collected. There were 2 males and 2 females and the age ranged from 24 to 41 years, with an average age of 33.5 years. The cause of injury included traffic accident in 3 cases and falling in 1 case. Pipkin classification was 2 cases of type Ⅰ and 2 cases of type Ⅱ. The time from injury to operation was 1-2 days. The clinical features were that the hip joint of the affected limb was in a locked position, and the passive range of motion was poor. The affected limb was slightly flexed at the hip joint and shortened, in a state of neutral position or slight adduction and internal rotation. The imaging data suggested that the femoral head dislocated backward and upward, and the hard cortex of the posterior edge of the acetabulum was embedded in the cancellous bone of the femoral head, and the two were compressed and incarcerated. Patients of cases 1-3 underwent closed reduction of hip dislocation 1-2 times at 3, 1, and 3 hours after injury respectively, and femoral neck fracture occurred. The injury types changed to Pipkin type Ⅲ, and open reduction and internal fixation were performed. Patient of case 4 did not undergo closed reduction, but underwent open reduction and internal fixation directly. Patients of cases 1-3 were followed up 14, 17, and 12 months, respectively. They developed osteonecrosis of the femoral head at 9, 5, and 10 months after operation respectively, and all underwent total hip arthroplasty. Patient of case 4 was followed up 24 months and had no hip pain and limited mobility; the imaging data indicated that the internal fixator position was good and the fracture healed; no collapse or deformation of the femoral head was seen, and no osteonecrosis of the femoral head occurred. Clinicians need to improve their understanding of the unique clinical features and imaging findings of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. It is suggested that open reduction and simultaneous fixation of femoral head fracture should be directly used to reduce the incidence of osteonecrosis of the femoral head.

Complications and Functional Outcome of Femoral Head Fracture-Dislocation In Delayed and Neglected Cases.

Delayed reduction of the hip in femoral head fracture dislocation increases the risk of osteonecrosis and adversely affects the functional outcome. This retrospective study was designed to evaluate the outcome and complications of 138 patients with femoral head fracture dislocation treated by a single surgeon over a period of 22years. Only seven patients presented within 24h of injury and remaining all presented late. The hip joints could be reduced by closed manoeuvre in 105 patients, and 33 patients needed open reduction. The patients were managed conservatively or surgically. The mean follow-up period was 3.57years (1-18years). There were 119 males and 19 females. The mean age was 35.71years (range, 18-70years). Forty-two patients were managed conservatively, and 96 patients needed surgical treatment. The Kocher-Langenbeck approach was used in 40 patients, the trochanteric flip osteotomy in 14 patients, the Smith-Peterson approach in 31 patients, and the Watson-Jones approach in one patient. The femoral head fragment was fixed in 47.82% patients and excised in 11.59% patients. Primary total hip replacement (THR) was performed in 7.24% of patients through the posterior approach. 24.63% of patients developed complications with 14.49% of hip osteonecrosis, 2.89% posttraumatic osteoarthritis and 2.17% femoral head resorption. 55% of patients who developed osteonecrosis were operated through the posterior approach. Secondary procedures were needed in 14.48% of patients. The clinical outcome, as evaluated using the modified Harris Hip Score, was good to excellent in 52.89% of patients and poor to fair in 47.11% of patients. The incidences of osteonecrosis and secondary procedures are increased in delayed and neglected femoral head fracture dislocation. Osteonecrosis is commonly seen in Brumback 2A injuries and posterior-based approaches. All Brumback 3B fractures in such delayed cases should be treated with THR. Osteosynthesis or conservative treatment should be reserved for other types of injuries. A careful selection of treatment plan in such delayed cases can result in a comparable functional outcome as reported in the literature.

Irreducible Femur Head Fracture-Dislocation Treatment With Kocher-Langenbeck Approach With Flip Trochanteric Osteotomy: A Novel Approach.

Femoral head fracture-dislocations are rare, and irreducible cases are even less frequent. Truly irreducible fracture-dislocations must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. The Pipkin classification is commonly used to classify femoral head fractures. An urgent reduction is required in traumatic hip dislocations to reduce the risk of avascular necrosis (AVN) of the femoral head. However, in femoral head fractures, the dislocated hip cannot be reduced easily due to incarcerated bone or soft tissue. In an irreducible fracture hip dislocation, It is not advisable to attempt to reduce it repeatedly because sometimes femoral head fracture-dislocation is associated with the impacted fracture of the femoral neck. It may lead to iatrogenic femoral neck fracture. Hence, in such cases, immediate open reduction and internal fixation are recommended. The Kocher-Langenbeck approach can be used for reduction and safe surgical dislocation with flip trochanteric osteotomy for fixation as a novel approach.

Surgical Dislocation or the Modified Heuter Anterior Approach for Pipkin I and II Femoral Head Fracture Dislocations.

To compare outcomes after surgical treatment of Pipkin I and II femoral head fractures treated with either a surgical dislocation (SD) or a direct anterior approach (the modified Heuter approach). Retrospective, multicentre. Three Level I trauma care centers. Fourty-nine patients operated for Pipkin types I or II femoral head fractures. Twenty-seven using SD and 22 using the modified Heuter approach. Initial closed reduction of the joint followed by open reduction and internal fixation of the fracture/fragment excision. Fixation was performed using headless or countersunk mini fragment screws. The 2 groups were compared for (1) perioperative measures: blood loss, surgical time, pain [visual analog scale (VAS)], and length of hospital stay; (2) radiological outcome in terms of fracture union, occurrence of posttraumatic hip arthritis, and femoral head osteonecrosis; and (3) functional outcome using the modified Merle d' Aubigne score and Oxford hip scores. Surgical time, blood loss, and VAS at 24 hours were significantly lower in the modified Heuter group. The VAS at discharge and length of stay were similar in both groups. All fractures had united. No cases of osteonecrosis were observed. Functional outcome and complications were similar in both groups. Both SD and the modified Heuter approach are effective in treating patients with Pipkin I and II femoral head fractures with comparable radiological and functional outcomes. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment of Fracture Dislocation of the Femoral Head in a Resource Limited Country (Burundi)

Introduction: Fractures of the femoral head are rare injuries which generally follow a traumatic dislocation of the hip or in a poly-trauma scenario. A fracture dislocation of the femoral head is an orthopedic emergency. The most frequent complications after a fracture of the femoral head are osteonecrosis, post traumatic arthritis and heterotopic ossification. Objective: To focus on the therapeutic aspect of fracture-dislocations of femoral head and their short- and long-term prognoses. Materials and Methods: This is a prospective study conducted at Kamenge teaching hospital and Rohero Christian medical and surgical clinic from January 2013 to August 2020. All patients diagnosed with fracture-dislocations of the femoral head were included in this study. Results: Five patients were admitted for fracture dislocation of the femoral head. The mean age was 40.4 years and varied between 25 and 55 years. The dashboard injury was the most common mechanism and was found in four patients (80%). A standard x-ray was performed for the five patients as well as CT scans in two cases. All patients had posterior iliac dislocations with fractures of the femoral head classified as Pipkin I in three patients and Pipkin III in two patients. Closed reduction under general anesthesia within six hours was possible in one among the five patients and within 12 hours in two patients. These three cases were managed with open reduction and internal fixation (ORIF) via anterior approach with screw fixation of the femoral head fragment. In the two remaining patients reduction was not possible and for one of them there was a femoral neck fracture following closed manipulation, making the fracture Pipkin III. The two patients with Pipkin III injuries were managed with total hip replacement. With an average follow up of five years, standard x-rays of the three patients who had ORIF showed fracture union without avascular necrosis, posttraumatic arthritis or heterotopic ossification. The functional results for the five patients with an average follow up of four years were very good (3/5) and good (2/5). Conclusion: The diagnosis of fracture dislocations of the femoral head was based on clinical, radiographic and computed tomography criteria. Early reduction and internal fixation can restore the natural anatomy of the hip joint, especially in young adults with a good long-term prognosis. Sometimes total hip replacement is necessary for management of fracture dislocations of the femoral head.

Clinical efficacy of surgical treatment for Pipkin fracture in 17 cases

To investigate the clinical effect of surgical treatment for femoral head fracture-dislocation (Pipkin fracture). Methods: A total of 17 patients with femoral head fracture-dislocation were retrospectively analyzed. The duration from injury to surgery was 1-30 (average 9.5) days. According to the classification of Pipkin criteria, there were 4, 6, 1, and 6 cases in Type I, Type II, Type III, and Type IV, respectively. Thirteen patients were treated with skin traction or bone traction after admission, and the postoperative traction lasted for 4 weeks. Results: All patients got a mean follow-up of 43(8-84) months. No patient suffered from infection and skin flap necrosis. X ray showed no implants loose or breakage. According to the Thompson-Epstein evaluation system, among the cases of Type I, 3 cases were excellent and 1 case was fair; among the cases of Type II, 3 cases were excellent, 2 cases were good, and 1 case was poor. The case of Type III was good. Among the cases of Type IV, 2 cases were excellent, 2 cases were good, and 2 cases were fair. The excellent and good rate was 76.47%. Conclusion: Early diagnosis of Pipkin fracture, reasonable selection of surgical approach and internal fixation according to Pipkin classification can help patients to obtain satisfactory hip function and improve their prognosis.

Hip arthroscopy-assisted reduction and fixation for femoral head fracture dislocations: Clinical and radiographic short-term results of seven cases.

Femoral head fracture dislocations are serious articular fractures that are associated with soft tissue injuries and are challenging to treat. Arthroscopic surgery may be a way to treat fracture reduction and fixation, thereby avoiding the need for extensive arthrotomy. We followed up a consecutive series of seven patients with femoral head fracture dislocation via a scope-assisted percutaneous headless screw fixation between 2016 and 2017. The clinical and radiological results were assessed. The locations of the fracture were all involving infra-foveal area. The mean follow-up duration was 18 (range 12-24) months. The mean Harris hip score was 90.8 (range 88-93) at the latest follow-up. None of the patients showed early osteoarthritis, heterotopic ossification, or avascular necrosis. The average maximal displacement of the fracture site was improved from preoperative 6.79 mm (range 4.21-12.32) to postoperative 2.76 mm (range 0.97-3.97). Concomitant intra-articular hip lesions secondary to traumatic hip dislocation can also be treated. Managing the infra-foveal fracture of the femoral head using arthroscopic reduction and fixation with headless screws can be a safe and minimally invasive option. More patients and longer follow-up are needed for a definite conclusion.

Treatment of Pipkin type II fracture dislocation of the femoral head: A case report and literature review

Rationale: Fractures of femoral head associated with a hip dislocation are relatively rare and often associated with a poor functional outcome. Fractures are characterised by a high risk of avascular necrosis of femoral head, is extremely rare. It is more difficult to treat and has a worse prognosis. Patient concerns: A 18 year old male with history of sustained injury over his left hip due to jump from running tractor that turned turtle. Pelvic radiograph and 3-D reconstruction computed tomography revealed characteristics of fracture dislocation of femoral head before the elective operation.Diagnosis: Pipkin type II fracture dislocation of femur head. Interventions: Firstly, dislocation was corrected by closed manual reduction under anesthesia. Secondly we used lateral approach to fix the femoral head fracture. Then we completed anatomical reduction of fractures with countersunk head screw. Outcomes: At 4 months follow up the patient could walk and perform activities of daily living without pain, limp, signs of necrosis of femoral head and heterotopic ossification. Conclusion: Treatment aim should always be the anatomical reduction of fragments with minimal soft tissue injury. Sometimes closed reduction is enough, but in the presence of large fragments, the fracture-dislocation is better treated by ORIF. We should not forget that half of these patients will have good outcomes no matter the treatment strategy. This result depends upon general health of the patient, the severity of the injury, associated cartilage injury, and timing of admission to hospital. Lessons: Although there are serious complications in Pipkin II fractures early surgical treatment with appropriate approach and fixation could get satisfactory results.

Clinical results of femoral head fracture-dislocation treated according to the Pipkin classification.

Objective:To summarize the clinical results of femoral head fracture-dislocation treated according to Pipkin classification.Methods:Atotal of 19 patients with femoral head fracture-dislocation were retrospectively analyzed from Mar. 2008 to Mar. 2015. According to the classification of Pipkin criteria, there were 4 cases in Type-I, 6 cases in Type-II, 6 cases in Type-IIIand 3 cases in Type-IV. Various procedures were taken according to the different types of the fracture, the time of the fracture, and the age of the patients. X-ray was examined during the follow-up period and functional evaluation was carried out by Harris Hip Score’s criteria. The clinical therapeutic effects were analyzed.Results:All the patientsgot a mean follow-up of 18 months (9-36 months). No patient suffered from infection, skin flap necrosis and X-ray showed no implants loosening or breakage. According to the Harris Hip Score’s criteria, in Type-I, 4 cases were rated as excellent. In Type-II, 2 cases rated as excellent, 3 cases as good and 1 case as fair. In Type-III, 3 cases rated as good, 2 cases as fair and 1 case as poor. In Type-IV, 1 case rated as excellent, 1 case as good and 1 case as fair. The overall rate of excellent and good was 73.7%.Conclusions:Pipkin classification is helpful to make preoperative plan and judging the prognosis in cases of femoral head fracture-dislocation. However, multiple factors such as the time from injury to surgery, the ages of patients, the selection of implants should also be considered, which may affect the clinical results.

A treatment strategy to avoid iatrogenic Pipkin type III femoral head fracture-dislocations.

Reduction is urgently required in cases of traumatic hip dislocation to decrease the risk of avascular necrosis of the femoral head. However, successful reduction may not always be feasible for hip dislocations associated with femoral head fractures. This irreducibility may provoke further incidental fractures of the femoral neck with resultant Pipkin type III injuries. The purpose of this study was to describe an appropriate treatment strategy for irreducible femoral head fracture-dislocations. We treated nine patients with irreducible hip dislocations with femoral head fractures (eight Pipkin type II and one type IV) for which reduction failed in the emergency room or operating theater. All of these cases required operative management. Five of the nine patients experienced femoral neck fractures after closed reduction were attempted. These five cases underwent joint replacement at the time of injury or after developing avascular necrosis of the femoral head. Analysis of radiographs and computed tomography (CT) scans revealed that the fractured femoral head was perched on the sharp angle of the posterior wall of the acetabulum in the irreducible hips. After recognizing the irreducibility, the other four cases underwent immediate open reduction without further attempts at closed reduction, which saved the natural hip joint without neck fracture or avascular necrosis. Repeated or forceful closed reduction of irreducible femoral head fracture-dislocation injuries may result in iatrogenic femoral neck fractures with Pipkin type III injuries. Before attempting reduction, careful examination of plain radiographs and CT images may be helpful for determining the safest treatment strategy.

Femoral head reduction osteoplasty for fracture dislocation: A surgical technique

BackgroundFemoral head fractures with subchondral impaction and cartilage loss are difficult to treat successfully. Although multiple surgical management options have been described, no one technique has proven superior, particularly in the young high-demand population. TechniqueA femoral head reduction osteoplasty was performed following a surgical dislocation of the hip. A peripherally based wedge of bone was resected off the damaged central third of the head followed by reduction and fixation of the remaining fragments. This technique resulted in a smaller yet congruent femoral head. MethodsA healthy 40-year old labourer sustained a traumatic crush injury while at work, resulting in a left femoral head fracture dislocation with an associated posterior wall acetabular fracture. Significant femoral head impaction and cartilage loss limited the treatment options. ResultsIntraoperative reduction and postoperative imaging demonstrated near anatomic reconstruction of femoral head with a congruent hip joint. Superiorly at the level of resection, the medial–lateral diameter was reduced by 5–6mm (approximately 12–15% the diameter of the original head) by the osteoplasty. At five years, Harris Hip Score was 86, Oxford Hip Score 36, and UCLA score 89. Hip abductor strength was full, range of motion near normal, and the patient ambulated without antalgia. Radiographs demonstrate a congruent joint and patchy avascular necrosis without collapse. The patient maintained full employment as a labourer. ConclusionsFemoral head reduction osteoplasty is a viable option that may produce durable intermediate-term results for complex femoral head fracture with superior impaction and chondral damage.Level of Evidence: Level V.

Internal fixation of femoral head fractures (Pipkin I) using hip arthroscopy

A hip arthroscopy technique for the reduction and internal fixation of a displaced femoral head fracture is presented. Open treatment is often required for femoral head fractures. However, it is shown below how large fragments of a femoral head fracture-dislocation were reduced and internally fixated using hip arthroscopy. This was performed in the supine position using skeletal traction. The accessory distal anterior portal was used for internal fixation when a hip was positioned in abduction with external rotation. A satisfactory outcome was reported. Recovery was immediate and cosmetics were excellent. We conclude that hip arthroscopy is a valuable option for managing femoral head fracture-dislocations (Pipkin I).

Posttraumatic Osteonecrosis of the Femoral Head after Nine Years of Posterior Femoral Head Fracture Dislocation

Posttraumatic osteonecrosis of the femoral head (ONFH) is the most serious complication after fracture dislocation of the femoral head. The rate of this complication was reported to range from 1.7% to 40%. Although the development of posttraumatic osteonecrosis normally occurs within 2 years of injury, there are some reports of the late development ONFH. The authors encountered a case of posttraumatic ONFH that developed after 9 years of a Pipkin type I fracture dislocation. The patient was treated by modified transtrochanteric rotational osteotomy. We report this rare case with a review of the relevant literatures.

Hip Arthroscopic Management for Femoral Head Fractures and Posterior Acetabular Wall Fractures (Pipkin Type IV)

Femoral head fractures associated with acetabular fractures are usually treated by an open method. After a closed reduction of a hip dislocation, open reduction and internal fixation of acetabular fractures usually depend on the type of acetabular fracture. Acetabular fractures associated with femoral head fractures, torn labrums, or osteochondral fractures are often managed simultaneously by a posterior approach. The patient in this study was referred to us because of pain and limited motion after open reduction and internal fixation of an acetabular fracture. Postoperative computed tomography showed remnant osteochondral fragments located in the cotyloid fossa. Using hip arthroscopy, we found a torn labrum and multiple osteochondral fragments in the cotyloid fossa. The avulsed torn labrum was reattached with 2 anchors through the midanterior portal. Osteochondral fragments were curetted and removed. This article reviews the treatment of the torn labrum and multiple fragments after acetabular fracture reduction. The patient recovered immediately and had a satisfactory outcome. We conclude that hip arthroscopy is a valuable option for treating femoral head fracture dislocations associated with acetabular fractures.

Rotational Osteoplasty for Femoral Head Fracture With Cartilage Loss

Femoral head fractures often result in damage to the articular cartilage. This article describes a patient who sustained a femoral head fracture-dislocation with significant damage to the articular cartilage of the weight-bearing portion of his femoral head (A). After anatomic reduction of the fracture, a 2×4-cm osteochondral articular defect existed at the weight-bearing portion of the femoral head (B). The femoral head fragment was rotated such that the superior weight-bearing surface was congruent (C). This created a small gap at the inferior aspect of the femoral head, which was filled using a small corticocancellous graft harvested from the greater trochanter. The femoral head fragment was fixed with countersunk 3.5-mm screws. At 18-month follow-up, the patient had returned to full-time construction work with no limitations. He reported no pain in his hip or any activity limitations, and his Harris Hip Score was 91 points. Radiographs obtained 18 months postoperatively showed healing of the femoral head and preservation of the hip joint.

Is femoral head fracture-dislocation management improvable: A retrospective study in 110 cases

There is no established consensus on the diagnosis and treatment of traumatic fracture-dislocation of the femoral head --largely due to the rarity of this injury. Analysis of a large series of fracture-dislocations of the femoral head using a single coherent classification should enable the means of diagnosis and treatment of fracture-dislocations of the femoral head to be specified. The hypothesis was tested by analyzing a retrospective series of 110 patients charts admitted between 1972 and 2008, using Pipkin's classification and an alternative new one, Chiron's classification. The series comprised 21 women and 89 men; mean age: 37.1 years. Dislocation was posterior in 102 cases and anterior in eight. Associated lesions comprised 46 fractures of the acetabulum and four of the femoral neck. Classification following Pipkin and Chiron was based on double reading of radiology documents from 102 patients. Treatment was exclusively conservative in 32 cases, and surgical in 78, with 51 posterior, 19 anterior and four medial approaches and four arthroscopic procedures. Surgery comprised osteosynthesis of the femoral head in 30 cases and of the acetabulum in 16, removal of fragments in 40 cases and total hip replacement (THR) in five cases as a primary treatment. Mean follow-up was 37 months. THR was performed in 25 cases: five as a primary treatment and 20 secondarily, 15 of which were performed within the first 6 months. Significant predictive factors for THR were: old age, Chiron grade 3, and femoral neck fracture. The THR and non-THR groups differed on the Chiron but not on the Pipkin classification at the time of the injury. Specific treatments were not predictive of evolution. Fragment removal was more often by a posterior than an anterior or medial approach. The Chiron classification showed prognostic value for evolution to THR; to be reproducible, it needs to be based on CT data. No particular mode of treatment emerged as preferable. Better initial lesion analysis should enable prognosis and target indications. Level IV Retrospective study.

Irreducible Pipkin II femoral head fractures: Is transgluteal approach the best strategy?

Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment. Level IV retrospective historical study.

The Use Osteochondral Allograft in the Treatment of a Severe Femoral Head Fracture

This study reviews the second case in the literature involving the use of frozen osteochondral allograft to reconstruct a femoral head fracture-dislocation. The case involved significant, unreconstructable damage to the weightbearing area of the femoral head in an 18-year-old male. Clinical and diagnostic imaging follow up at 46 months revealed that despite magnetic resonance imaging and radiographic evidence of progressive arthrosis in the hip, including subchondral cystic change in the femoral head and localized cartilage loss in the acetabulum and femoral head, the patient had excellent function with no complications (Harris hip score 100, hip dysfunction and osteoarthritis outcome score 62, musculoskeletal function assesment score 22, SF-36 score 81). The use of osteochondral allograft may serve as a useful tool for the orthopaedic surgeon faced with an unreconstructable femoral head fracture-dislocation in a young patient.