Femoral Head Fractures - Orthopaedic Trauma - Lecture Slides, Slides of Orthopedics

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Femoral Head Fractures

Treatment principles similar to those listed for hip dislocations. Docsity.com

Femoral Head Fractures – Mechanism

• Fracture occurs by shear as femoral head dislocates.
• With less hip flexion, femoral head fracture tends to be larger.

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History and Physical Examination

Similar to patient with hip dislocation.

Patient posture may be less extreme due to femoral head fracture.

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Classification

Thomas and Epstein Type V

• Hip dislocation with femoral head fracture

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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

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Pipkin IV

• Femoral head fracture with acetabulum fracture.
• High incidence of post-traumatic AVN. Docsity.com

Femoral Head Fracture:

Radiographic Evaluation

• AP Pelvis X-Ray
• Lateral Hip X-Ray
• Judet views
• Post-reduction CT Scan

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CT Scan

Essential to evaluate quality of reduction of femoral head fracture (congruence), as well as intra-articular fragments. Docsity.com

Displaced Infra-foveal Fractures

Can be reduced and stabilized, or excised.

ORIF preferred if possible.

Anterior approach allows best visualization. Docsity.com

Posterior vs Anterior Approach

• Support for Posterior Approach
  • Sarmiento, CORR 1973
  • Epstein, JBJS 1974 (0 good results with ant. approach)
• Support for Anterior Approach
  • Swiontkowski, Thorpe, Seiler, Hansen, J Orthop Trauma 1992: - 12 anterior, 12 posterior. - Less blood loss and operative time with anterior approach. - Improved visualization anteriorly. - Increased H.O. anteriorly. - 67% good and excellent in each group.
  • Nork, Routt et al, OTA 2001: 21 cases,? one AVN Docsity.com

Supra-foveal Fractures

ORIF through:

1. anterior approach.
2. posterior approach.
3. posterior approach with Ganz trochanteric flip osteotomy.

Excision of fragment(s) will create instability, and thus is contraindicated.

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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. Docsity.com

Femoral Head 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). Docsity.com

Femoral Head Fracture-Dislocation with

Non-Displaced Femoral Neck Fracture

Must consider stabilizing femoral neck fracture before performing reduction of hip. Docsity.com

Reduction Maneuver Results in

Displaced Femoral Neck Fracture

• Emergent open reduction of hip from side of dislocation.
• Reduction and stabilization of femoral neck fracture.
• Assessment of femoral head fracture for surgical indications.
• In elderly, perform arthroplasty. Docsity.com

Pipkin IV Fractures

Require appropriate treatment of femoral head and acetabulum fractures. Combination of fractures necessitates critical assessment of stability. Have high incidence of post-traumatic osteoarthritis. Docsity.com

Femoral Head Fracture with Acetabulum

Fractures

Kregor, AAOS, 2004

• 10 cases followed 28 months
• All had ORIF of both femoral head and acetabulum
• 6 Ganz trochanteric flip osteotomy, 3 anterior + posterior, 1 posterior.
• Results: 3 excellent, 6 good, 1 poor.
• “The Ganz Trochanteric Flip Osteotomy combined with surgical dislocation of the hip allows for optimal visualization and fixation of both injuries, controlled reduction of the hip, and thorough debridement of the hip joint.” Docsity.com