Outcomes of Treatment for Femoral Head Fractures with Hip Dislocation - Review of 20 Cases -

Ji Wan Kim; Jae Suk Chang; Joo Yul Bae; Jung Jae Kim

doi:10.5371/jkhs.2010.22.4.298

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Kim, Chang, Bae, and Kim: Outcomes of Treatment for Femoral Head Fractures with Hip Dislocation - Review of 20 Cases -

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2010; 22(4): 298-304.

Published online: 31 December 2010

DOI: https://doi.org/10.5371/jkhs.2010.22.4.298

Outcomes of Treatment for Femoral Head Fractures with Hip Dislocation - Review of 20 Cases -

Ji Wan Kim, MD^*, Jae Suk Chang, MD, Joo Yul Bae, MD, Jung Jae Kim, MD

Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Uiversity of Ulsan, Seoul, Korea.

^*Department of Orthopedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea.

Address reprint request to Jung Jae Kim, MD. Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. TEL: +82-2-3010-3538, FAX: +82-2-488-7877, jjkim2@amc.seoul.kr

Received 9 June 2010 Revised 17 November 2010 Accepted 27 November 2010

Abstract

Purpose

We wanted to assess the clinical results and the complications of treating femoral head fractures.

Materials and Methods

Twenty patients with femoral head fractures and who had a minimum 1 year follow up were enrolled in this study from April 2004 to June 2008. The clinical outcomes were evaluated according to the mechanism of injury, the reduction time, the Pipkin classification, the treatment methods, the surgical approach and the complications.

Results

There were 5 cases of Pipkin type I and 2 cases of Pipkin type II, 1 case of Pipkin type III and 12 cases of Pipkin type IV. All the patients underwent operation except 1 patient; there were 5 excisions, 7 internal fixations, 1 prosthesis, and 6 internal fixations of combined acetabular fixation without surgery for the femoral head fractures. The average Harris hip score at 1 year after operation was 80.0 (range: 57~99): there were 4 excellent, 7 good, 5 fair and 4 poor results. The complications of the femoral head fractures were 2 cases of avascular necrosis and 2 cases of posttraumatic osteoarthritis.

Conclusion

Internal fixation of the femoral head with using Herbert screws showed a favorable outcome, while excision of the femoral head fragments did not. Internal fixation of Pipkin type 1 or 2 fractures could be performed by the anterior approach. The posterior approach combined with surgical dislocation is especially useful in internal fixation of concurrent posterior acetabular fractures, and it has the advantage of preserving the blood supply to the femoral head.

Keywords: Femur, Femoral head fracture, Hip dislocation, Outcomes, Complications

Figures and Tables

Fig. 1

Case 7. A 36-year-old man (A) Initial both hip Anteroposterior (AP) view and (B) pelvis CT image show Pipkin type 2 femoral head fracture. (C) Internal fixation of femoral head through the anterior approach was done. (D) The last follow-up both hip AP x-ray at postoperative 34 months shows healing of fracture and heterotopic ossification, but there is no evidence of avascular necrosis of femoral head or post-traumatic osteoarthritis.

Fig. 2

Case 20. A 48-year-old man (A) Initial both hip Anteroposterior (AP) view and (B) pelvis CT image show Pipkin type 4 femoral head fracture. (C) Internal fixation of femoral head and acetabulum through the posterolateral approach with trochanter flip osteotomy was done. (D) The last follow-up both hip AP x-ray at postoperative 53 months shows healing of fracture, but there is no evidence of avascular necrosis of femoral head or post-traumatic osteoarthritis.

Table 1

The Characteristics of 20 Patients

^* Follow-up, ^† Open Reduction Internal Fixation, ^‡ Bipolar hemiarthroplasty, ^§Harris Hip Score, ^∥Fair, ^¶ Good, ^** Excellent, ^††Poor, ^‡‡ Heterotopic ossification, ^§§Post-traumatic Osteoarthritis, Avascular Necrosis of Femoral Head

Table 2

Surgical Approaches

Table 3

The Clinical Outcomes of Femoral Head Fracture According to Pipkin Classification and the Method of Surgery

^* Open reduction and internal fixation of acetabulum, not femoral head fracture

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