Updates on Treatment of Femoral Head Fractures

Ji Wan Kim; Jae Hyun Kim

doi:10.4055/jkoa.2015.50.3.171

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Kim and Kim: Updates on Treatment of Femoral Head Fractures

Symposium

Proximal Femur Fractures

Journal of the Korean Orthopaedic Association 2015; 50(3): 171-177.

Published online: 30 June 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.3.171

Updates on Treatment of Femoral Head Fractures

Ji Wan Kim, M.D., Ph.D., Jae Hyun Kim, M.D.

Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Correspondence to: Ji Wan Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan 612-896, Korea. TEL: +82-2-51-797-0668, FAX: +82-51-797-0669, bakpaker@hanmail.net

Received 4 June 2015 Accepted 8 June 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: femur, femoral head, femoral head fracture, treatment

Figures and Tables

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.

Table 1

Treatment Options for Femoral Head Fractures according to Pipkin Type

^*If the hip is not reducible by closed method, a posterior approach is favorable. Nonsurgical treatment is possible in the presence of anatomic or near-anatomic reduction, a stable hip joint, and no incarcerated fragments

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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