Skip to main content
SpringerLink
Log in

Femoral Head Fractures

  • Reference work entry
  • First Online:
Hip Arthroscopy and Hip Joint Preservation Surgery

Abstract

Fractures of the femoral head are rare high-energy injuries that are commonly associated with posterior dislocations of the hip. Controversy exists regarding many aspects of treatment of these fractures, but following emergent reduction of associated hip dislocations, anatomic reduction of large fracture fragments, removal of loose intra-articular fragments, and restoration of hip joint stability and congruity are recommended. Reported outcomes on these fractures continue to be relatively poor, despite advances in approaches and implant design. High rates of posttraumatic arthritis, avascular necrosis, and heterotopic ossification are common. The purpose of this chapter is to summarize the available literature on femoral head injury mechanisms and epidemiology, classification systems, and treatment options (operative vs. nonoperative and associated outcomes) and to propose potential mechanisms for improving outcomes in these rare, high-energy injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 699.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 799.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Birkett J. Description of a dislocation of the head of the femur, complicated with its fracture; with remarks. Med Chir Trans. 1869;52:133–8.

    Article  CAS  Google Scholar 

  2. Chen GX, Yang L, Li K, et al. A three-dimensional finite element model for biomechanical analysis of the hip. Cell Biochem Biophys. 2013;67(2):803–8.

    Article  CAS  Google Scholar 

  3. Harris MD, Anderson AE, Henak CR, Ellis BJ, Peters CL, Weiss JA. Finite element prediction of cartilage contact stresses in normal human hips. J Orthop Res. 2012;30(7):1133–9.

    Article  Google Scholar 

  4. Greenwald AS, O’Connor JJ. The transmission of load through the human hip joint. J Biomech. 1971;4(6):507–28.

    Article  CAS  Google Scholar 

  5. Rushfeldt PD, Mann RW, Harris WH. Improved techniques for measuring in vitro the geometry and pressure distribution in the human acetabulum. II Instrumented endoprosthesis measurement of articular surface pressure distribution. J Biomech. 1981;14(5):315–23.

    Article  CAS  Google Scholar 

  6. Armstrong CG, Gardner DL. Thickness and distribution of human femoral head articular cartilage. Changes with age. Ann Rheum Dis. 1977;36(5):407–12.

    Article  CAS  Google Scholar 

  7. Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82(5):679–83.

    Article  CAS  Google Scholar 

  8. Grose AW, Gardner MJ, Sussmann PS, Helfet DL, Lorich DG. The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip. J Bone Joint Surg Br. 2008;90(10):1298–303.

    Article  CAS  Google Scholar 

  9. Giannoudis PV, Kontakis G, Christoforakis Z, Akula M, Tosounidis T, Koutras C. Management, complications and clinical results of femoral head fractures. Injury. 2009;40(12):1245–51.

    Article  CAS  Google Scholar 

  10. Henle P, Kloen P, Siebenrock KA. Femoral head injuries: which treatment strategy can be recommended? Injury. 2007;38(4):478–88.

    Article  Google Scholar 

  11. Upadhyay SS, Moulton A, Burwell RG. Biological factors predisposing to traumatic posterior dislocation of the hip. A selection process in the mechanism of injury. J Bone Joint Surg Br. 1985;67(2):232–6.

    Article  CAS  Google Scholar 

  12. DeLee JC, Evans JA, Thomas J. Anterior dislocation of the hip and associated femoral-head fractures. J Bone Joint Surg Am. 1980;62(6):960–4.

    Article  CAS  Google Scholar 

  13. Droll KP, Broekhuyse H, O’Brien P. Fracture of the femoral head. J Am Acad Orthop Surg. 2007;15(12):716–27.

    Article  Google Scholar 

  14. Pipkin G. Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am. 1957;39-A(5):1027–42 passim.

    Google Scholar 

  15. Brumback RJ, Kenzora JE, Levitt LE, Burgess AR, Poka A. Fractures of the femoral head. Hip. 1987;1987:181–206.

    Google Scholar 

  16. Kloen P, Siebenrock KA, Raaymaker E, Marti RK, Ganz R. Femoral head fractures revisited. Eur J Trauma. 2002;4:221–33.

    Article  Google Scholar 

  17. Hougaard K, Thomsen PB. Coxarthrosis following traumatic posterior dislocation of the hip. J Bone Joint Surg Am. 1987;69(5):679–83.

    Article  CAS  Google Scholar 

  18. Mehta S, Routt ML Jr. Irreducible fracture-dislocations of the femoral head without posterior wall acetabular fractures. J Orthop Trauma. 2008;22(10):686–92.

    Article  Google Scholar 

  19. 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(7):1077–81.

    Article  Google Scholar 

  20. Bozic KJ, Chan V, Valone FH III, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplast. 2013;28(8 Suppl):140–3.

    Article  Google Scholar 

  21. Yamamoto Y, Ide T, Ono T, Hamada Y. Usefulness of arthroscopic surgery in hip trauma cases. Arthroscopy. 2003;19(3):269–73.

    Article  Google Scholar 

  22. Mullis BH, Dahners LE. Hip arthroscopy to remove loose bodies after traumatic dislocation. J Orthop Trauma. 2006;20(1):22–6.

    Article  Google Scholar 

  23. Matsuda DK. A rare fracture, an even rarer treatment: the arthroscopic reduction and internal fixation of an isolated femoral head fracture. Arthroscopy. 2009;25(4):408–12.

    Article  Google Scholar 

  24. Park MS, Yoon SJ, Choi SM. Arthroscopic reduction and internal fixation of femoral head fractures. J Orthop Trauma. 2014;28:3164–8.

    Article  Google Scholar 

  25. Ross JR, Gardner MJ. Femoral head fractures. Curr Rev Musculoskelet Med. 2012;5(3):199–205.

    Article  Google Scholar 

  26. Swiontkowski MF, Thorpe M, Seiler JG, Hansen ST. Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures. J Orthop Trauma. 1992;6(4):437–42.

    Article  CAS  Google Scholar 

  27. Wang S, Li B, Zhang Z, Yang H, Liu L. Comparison of the modified Heuter approach and the Kocher-Langenbeck approach to treatment of Pipkin type I and II femoral head fractures. Int Orthop. 2019;43:2613–20.

    Article  Google Scholar 

  28. Guo JJ, Tang N, Yang HL, Qin L, Leung KS. Impact of surgical approach on postoperative heterotopic ossification and avascular necrosis in femoral head fractures: a systematic review. Int Orthop. 2010;34(3):319–22.

    Article  Google Scholar 

  29. Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83(8):1119–24.

    Article  CAS  Google Scholar 

  30. Gardner MJ, Suk M, Pearle A, Buly RL, Helfet DL, Lorich DG. Surgical dislocation of the hip for fractures of the femoral head. J Orthop Trauma. 2005;19(5):334–42.

    PubMed  Google Scholar 

  31. Solberg BD, Moon CN, Franco DP. Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures. Clin Orthop Relat Res. 2009;467(4):929–33.

    Article  Google Scholar 

  32. Holmes WJ, Solberg BD, Bay BK, Laubach JE, Olson SA. Biomechanical consequences of excision of displaced Pipkin femoral head fractures. J Orthop Trauma. 2000;14(2):149–50.

    Article  Google Scholar 

  33. Prokop A, Helling HJ, Hahn U, Udomkaewkanjana C, Rehm KE. Biodegradable implants for Pipkin fractures. Clin Orthop Relat Res. 2005;432:226–33.

    Article  Google Scholar 

  34. Giannoudis PV. Pipkin type III fractures of the femoral head: fix it or replace it? Injury. 2017;48:2375–8.

    Article  Google Scholar 

  35. Scolaro JA, Maracek G, Firoozabadi R, Krieg JC, Routt ML. Management and radiographic outcomes of femoral head fractures. J Orthop Traumatol. 2017;18:235–41.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Emory University, Grady Memorial Hospital, Atlanta, GA, USA

    Mara L. Schenker

  2. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Max E. Davis & Jaimo Ahn

  3. Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Jaimo Ahn

Authors
  1. Mara L. Schenker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Max E. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jaimo Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaimo Ahn .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Division of Sports Medicine, Section of Young Adult Hip Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  2. Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Asheesh Bedi

  3. Department of Orthopaedic Surgery, Joint Preservation and Cartilage Restoration Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    Michael J. Salata

  4. Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA

    Richard C. Mather III

  5. Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Center for Hip Preservation Surgery Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY, USA

    Bryan T. Kelly

Section Editor information

  1. Premier Hip Arthroscopy, Marina del Rey, CA, USA

    Dean K. Matsuda

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Schenker, M.L., Davis, M.E., Ahn, J. (2022). Femoral Head Fractures. In: Nho, S.J., Bedi, A., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-43240-9_86

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-43240-9_86

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43239-3

  • Online ISBN: 978-3-030-43240-9

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation