J Korean Orthop Assoc.  2015 Jun;50(3):171-177. 10.4055/jkoa.2015.50.3.171.

Updates on Treatment of Femoral Head Fractures

• Kim JW
• Kim JH

• KMID: 1851951
• DOI: http://doi.org/10.4055/jkoa.2015.50.3.171

Abstract

Fracture of the femoral head is relatively uncommon and usually caused by high energy injury. The femoral head fracture combined with hip dislocation results in severe damage to the hip joint, and therefore has been associated with poor functional outcome. The principle of the treatment is composed of urgent reduction of the dislocated hip and early anatomical reduction, with the goal of restoring a congruent and stable hip. In an effort to reach that goal, several methods have been used for treatment of the fracture after closed reduction of the hip. The purpose of this article is to review the indication of surgery, surgical methods, surgical approach, and clinical outcomes.

Keyword

femur; femoral head; femoral head fracture; treatment

MeSH Terms

Femur
Head*
Hip
Hip Dislocation
Hip Joint

Figure

• 

  Figure 1 The Pipkin classification. (A) Type I, femoral head fracture inferior to the fovea centralis. (B) Type II, fracture extended superior to the fovea centralis. (C) Type III, any femoral head fracture with an associated femoral neck fracture. (D) Type IV, any femoral head fracture with an associated acetabular fracture.

• 

  Figure 2 (A) A 68-year-old female had a left hip dislocation with Pipkin type I femoral head fracture. (B) Anteroposterior of both hips and (C, D) computed tomography showing congruent hip and anatomical reduction (<2 mm) after closed reduction. (E) One-year-follow up X-ray showing no evidence of osteonecrosis of the femoral head or arthritis.

• 

  Figure 3 (A) A 24-year-old female had a left hip dislocation with Pipkin type II femoral head fracture. (B) Anteroposterior of both hips showing successful reduction, but non-anatomical reduction of the femoral head. (C, D) Internal fixation was performed with headless screws using the Smith-Peterson approach. (E) Two-year-follow up X-ray demonstrating heterotopic ossification, but no evidence of osteonecrosis of the femoral head or arthritis.

• 

  Figure 4 (A) A 52-year-old male had a left hip dislocation with Pipkin type II femoral head fracture. (B) Failed reduction resulted in an emergency open reduction and internal fixation. A photo showed a posteriorly dislocated femoral head. (C) After surgical dislocation, the left femoral head and neck were exposed. (D) After anatomical reduction, provisionary K-wires were fixed. (E) Internal fixation with headless screws was performed. (F) Postoperative X-ray showing anatomical reduction and congruent hip. (G) Two-year-follow up X-ray demonstrating mild heterotopic ossification, but no evidence of osteonecrosis of the femoral head or arthritis.

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