Surgical treatment of femoral head fractures

Abstract

Background Femoral head fractures (FHF) are uncommon and generally caused by high-energy injuries. Surgical reduction with stable fixation of large fragments is believed to have the best outcomes. This retrospective study intended to report outcomes with surgical treatment at our institution and tried to establish treatment algorithm. Methods Through the 6-year period (2003 – 2008) , 35 FHF in 35 consecutive patients (average, 30 years) were surgically treated. All FHF were caused by high-energy trauma. Patients' general condition was stabilized first and hip dislocation was manually reduced immediately. Definite fracture treatment was scheduled after admission for an average of 2.9 days (0.3–11 days). Pipkin classification was used as the treatment guide and open reduction with internal fixation was performed in all 35 FHF. Results These FHF included 21 type I, 7 type II, 3 type III, and 4 type IV fractures. The hip joint had been approached by either an anterior or posterior route depending on the individual surgeon. Internal fixation with screws was performed for all 35 FHF. The average admission was 13.8 days (range, 2–35 days). Thirty patients (86%, 30/35) were followed for an average of 3.3 years (at lease 6 months) and all 30 FHF healed. Avascular necrosis of the femoral head was found in 23% (7/30) patients and six patients were converted to hip arthroplasty for developing advanced stages of avascular necrosis. Heterotopic ossification occurred in 43% (13/30) patients. However, only one patient had range of motion limitation. Besides, one patient had moderate hip osteoarthritis. Conclusions FHF are uncommon and generally caused by high-energy injuries. Fracture healing can be attained in all femoral head fractures by using open reduction and screw fixation. Our results by using conventional approaches were associated with high complication rates. Further endeavor to improve the outcome should be taken.

Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis

“…In the systematic review by Guo et al [ 35 ], HO formation was lower in the SHD group (33.3%) compared to the S-P or K-L approaches (42.1% and 36.9%), although the difference was not statistically significant. In a study by Peng et al [ 40 ] reporting their results of treating FHFs at an average follow up of 3.3 years, 18 patients treated through the S-P approach, and 6 through the K-L approach, the overall incidence of HO was 43%. No surgical intervention was needed.…”

“…In the study by Del Core et al [ 29 ], 1 patient (5%) developed a postoperative infection. In a study by Peng et al [ 40 ], no deep infection was reported.…”

“…Second, one crucial point that was not assessed is the experience of the surgeon with this approach. Some authors reported having no familiarity with this approach[ 40 ]. On the other hand, in two studies[ 14 , 19 ] included in the meta-analysis, the authors reported having previous experience with the SHD approach; however, we found it unmeasurable and challenging to state the learning curve needed to master this technique.…”

Management of a Pipkin Type III Femoral Head Fracture Via Ganz Approach with a Cannulated Lag Screw & Herbert Screw

“…Since the Pipkin type fracture is often combined with a femoral neck fracture, the possibility of postoperative femoral head necrosis is very high. It is for this reason that many studies recommend hip replacement [29,30]. At present, the surgical approach and xation methods for Pipkin type III fractures remains controversial.…”

Surgical Approaches for Managing Femoral Head Fractures (FHFs); What and How to Choose from the Different Options?

“…The surgeon should be trained and familiar with the approach, as some authors reported an inability to use this approach due to unfamiliarity. 38 …”