Table Of Contents
Femoral Head Fracture
Femoral head fractures are rare injuries that are usually associated with hip dislocation (10%). In posterior dislocation the femoral head hits the posterior rim of the acetabulum and fractures. On the other hand, anterior dislocation causes impaction or indentation fractures of the head. Treatment may be non-operative or operative depending on the location of the fracture and displacement.
Pipkin classification of femoral head fracture
| Classification | Description | Treatment |
|---|---|---|
| Type I | Fracture is inferior to fovea. Does not involve the weight bearing portion of the femoral head. | Excision of small fragment, fixation if the fragment if large |
| Type II | Fracture is superior to the fovea. Involves the weight bearing portion of the femoral head. | Open reduction internal fixation |
| Type III | Type I or II with associated femoral neck fracture. Has a high incidence of avascular necrosis. Closed reduction may displace the neck fracture | Stabilize femoral neck fracture before attempting to reduce or fix the dislocated head |
| Type IV | Type I or II with associated acetabular fracture (posterior wall fracture) | Fixation if the fragment if large |
- Mechanism of injury
- High-energy e.g. MVA (dashboard injury), fall from height or sports
- Associated injuries
- Knee instability due to posterior cruciate ligament injury (dashboard injury)
- Femoral neck fracture
- Acetabular fracture
- Avascular necrosis of the femoral
- Sciatic nerve injury
- Signs and symptoms
- Hip pain
- Inability to bear weight
- Shortening
- Flexion, adduction and internal rotation (posterior hip dislocation)
- Flexion, abduction and extenral rotation (anterior hip dislocation)
- Signs of sciatic nerve injury
- Investigations
- X-ray (AP pelvis, judet view, inlet and outlet view): to evaluate pre- and post-reduction associated acetabular fracture and associated pelvic ring injury respectively
- CT scan: to evaluate fracture fragment post-reduction
- Emergency treatment
- Reduce hip dislocation within 6 hours (unless there is an associated femoral neck fracture)
- Indications for non-operative treatment
- Pipkin I
- Non displaced pipkin II < 1mm step off
- Stable hip joint
- Indications for operative treatment
- Pipkin II with > 1 mm step off
- Removal of loose bodies
- Femoral neck fracture (pipkin III)
- Acetabular fracture (pipkin IV)
- Polytrauma
- Irreducible fracture-dislocation
- Non-operative treatment
- Touch down weight bearing for 4 – 6 weeks
- Restrict adduction and internal rotation
- Operative treatment
- Open reduction internal fixation
- Arthroplasty
- Comlpications
- Post-traumatic osteoarthritis (50%)
- Avascular necrosis (20%)
- Heterotopic ossification
- Sciatic nerve injury
- Reduced internal rotation
- Malunion
- Non-union
