Abstract
Purpose
This study analyzed the clinical and radiological long-term follow-up results of patients with femoral head fracture who received surgical treatments.
Materials and Methods
Retrospective evaluation was performed for 20 patients with femoral head fracture who received surgical treatments between December 1997 and May 2010. According to Pipkin's classification, there were five type I, six type II, one type III, and eight type IV fractures.
Results
The average Merle d'Aubigne'-Postel score was 12.8 (12.80±3.53). According to surgical method, the score for the bony fragment excision group was 9.8 (9.83±2.79), and that for the open reduction and internal fixation group was 13.9 (13.92±3.07). Depending on Thompson-Epstein criteria, two patients were good, two were fair, and two were poor in the bony fragment excision group. Four patients were excellent, six were good, and three were poor in the open reduction and internal fixation group.
Figures and Tables
Fig. 1
A 36-year-old male patient who initially underwent excision for femoral head fracture and internal fixation for femoral shaft fracture. After 94 months of trauma, total hip arthroplasty was performed due to traumatic osteoarthritis and avascular necrosis of the femoral head. (A) Immediate X-ray and computed tomography after trauma. (B) X-ray after bony fragment excision. (C) At 93 months after initial surgery, the femoral shaft fracture was well united. Heterotopic ossification, arthritis, and avascular necrosis developed. (D) Total hip arthroplasty was performed.
![jkfs-27-198-g001](/upload/SynapseData/ArticleImage/0104jkfs/jkfs-27-198-g001.jpg)
Fig. 2
A 49-year-old female patient who initially underwent open reduction and internal fixation of a femoral head fracture. (A) Immediate X-ray and computed tomography after trauma. (B) X-ray after closed reduction. (C) X-ray after open reduction and internal fixation using an acutrak device. (D) Thirty-one months after open reduction and internal fixation, showing no radiologic complications.
![jkfs-27-198-g002](/upload/SynapseData/ArticleImage/0104jkfs/jkfs-27-198-g002.jpg)
References
1. Chakraborti S, Miller IM. Dislocation of the hip associated with fracture of the femoral head. Injury. 1975; 7:134–142.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
2. Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop Relat Res. 1985; (201):9–17.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
3. Roeder LF Jr, DeLee JC. Femoral head fractures associated with posterior hip dislocation. Clin Orthop Relat Res. 1980; (147):121–130.
4. DeLee JC, Evans JA, Thomas J. Anterior dislocation of the hip and associated femoral-head fractures. J Bone Joint Surg Am. 1980; 62:960–964.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
5. Epstein HC. Posterior fracture-dislocations of the hip comparison of open and closed methods of treatment in certain types. J Bone Joint Surg Am. 1961; 43:1079–1098.
6. Jukkala-Partio K, Partio EK, Hirvensalo E, Rokkanen P. Absorbable fixation of femoral head fractures. A prospective study of six cases. Ann Chir Gynaecol. 1998; 87:44–48.
7. Murray P, McGee HM, Mulvihill N. Fixation of femoral head fractures using the Herbert screw. Injury. 1988; 19:220–221.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
8. Birkett J. Description of a dislocation of the head of the femur, complicated with its fracture; with remarks. Med Chir Trans. 1869; 52:133–138.
9. Uzel AP, Laflamme GY, Rouvillain JL. Irreducible Pipkin II femoral head fractures: is transgluteal approach the best strategy? Orthop Traumatol Surg Res. 2010; 96:695–701.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
10. Chen ZW, Lin B, Zhai WL, et al. Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial. Int Orthop. 2011; 35:1077–1081.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
11. Marchetti ME, Steinberg GG, Coumas JM. Intermediate-term experience of Pipkin fracture-dislocations of the hip. J Orthop Trauma. 1996; 10:455–461.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
12. Fernandes A. Traumatic posterior dislocation of hip joint with a fracture of the head and neck of the femur on the same side: a case report. Injury. 1981; 12:487–490.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
13. Solberg BD, Moon CN, Franco DP. Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures. Clin Orthop Relat Res. 2009; 467:929–933.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
14. Richards BS, Howe DJ. Anterior perineal dislocation of the hip with fracture of the femoral head. A case report. Clin Orthop Relat Res. 1988; (228):194–201.
15. Giannoudis PV, Kontakis G, Christoforakis Z, Akula M, Tosounidis T, Koutras C. Management, complications and clinical results of femoral head fractures. Injury. 2009; 40:1245–1251.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
16. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement Incidence and a method of classification. J Bone Joint Surg Am. 1973; 55:1629–1632.
17. Trueta J, Harrison MH. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br. 1953; 35:442–461.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
18. Mehta S, Routt ML Jr. Irreducible fracture-dislocations of the femoral head without posterior wall acetabular fractures. J Orthop Trauma. 2008; 22:686–692.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
19. Mowery C, Gershuni DH. Fracture dislocation of the femoral head treated by open reduction and internal fixation. J Trauma. 1986; 26:1041–1044.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
20. Epstein HC. Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Joint Surg Am. 1974; 56:1103–1127.