Femoral Head Fractures

Posted by e-Medical PPT
Femoral Head Fractures – Mechanism
Fracture occurs by shear as femoral head dislocates.
With less hip flexion, femoral head fracture tends to be larger.

Classification
Thomas and Epstein Type V
  Hip dislocation with femoral head fracture

Pipkin Classification
I Fracture inferior to fovea
II Fracture superior to fovea
III Fracture of femoral head with fracture of femoral neck
IV Fracture of femoral head with acetabulum fracture

Femoral Head Fracture - Radiographic Evaluation
AP Pelvis X-Ray
Lateral Hip X-Ray
Judet views
Post-reduction CT Scan

Displaced Infra-foveal Fractures
Can be reduced and stabilized, or excised.
ORIF preferred if possible.
Anterior approach allows best visualization.

Supra-foveal Fractures
ORIF through:
    anterior approach.
    posterior approach.
    posterior approach with Ganz     trochanteric flip osteotomy.
Excision of fragment(s) will create instability, and thus is contraindicated.

Pipkin III Fractures
High incidence of AVN with displaced fractures.
Relative indication for hemiarthroplasty in older patient.
If femoral head fracture is non-displaced, do not attempt manipulative reduction of hip until femoral neck is stabilized.

Fracture-Dislocation with Displaced Femoral Neck Fracture
Closed reduction attempts are futile.
ORIF in young: open reduction of hip, then reduction and stabilization of femoral neck and head.
Arthroplasty in middle-aged and elderly (No good results with ORIF reported in literature)....

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