Fracture occurs by shear as femoral head dislocates.
With less hip flexion, femoral head fracture tends to be larger.
Thomas and Epstein Type V
Hip dislocation with femoral head fracture
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
Post-reduction CT Scan
Displaced Infra-foveal Fractures
Can be reduced and stabilized, or excised.
ORIF preferred if possible.
Anterior approach allows best visualization.
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)....