Skip to main content

Femoral Head Fractures

  • Chapter
  • First Online:
Fracture Reduction and Fixation Techniques

Abstract

Femoral head fractures are rare but significant intra-articular and intracapsular fractures that often require emergent surgical management. Femoral head fractures can be classified using the Pipkin classification system and are commonly associated with posterior hip dislocations and high-energy mechanisms of injury. Care must be taken to assess preoperative radiographs and assess for presence of a hip dislocation, associated acetabular fractures, or femoral neck fractures, which all affect surgical approaches and management. Goals of surgical treatment focus on urgent closed reduction of the hip and then achieving an anatomic reduction of the articular surface, often through open reduction and internal fixation, with countersunk conventional screws, headless compression screws, or bioabsorbable fixation to minimize the risk of post-traumatic arthritis and osteonecrosis of the femoral head.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
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. 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. https://doi.org/10.1016/j.injury.2009.10.024.

    Article  CAS  PubMed  Google Scholar 

  2. Lang-Stevenson A, Getty CJ. The Pip-kin fracture-dislocation of the hip. Injury. 1987;18:264–9.

    Article  CAS  Google Scholar 

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

    Google Scholar 

  4. Pipkin G. Treatment of grade IV fracture-dislocation of the hip: a review. J Bone Joint Surg Am. 1957;39(5):1027–197.

    Article  Google Scholar 

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

    Article  Google Scholar 

  6. Beebe MJ, Bauer JM, Mir HR. Treatment of hip dislocations and associated injuries: current state of care. Orthop Clin. 2016;47(3):527–49.

    Article  Google Scholar 

  7. Giannoudis PV, et al. Management, complications and clinical results of femoral head fractures. Injury. 2009;40(12):1245–51.

    Article  CAS  Google Scholar 

  8. 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 

  9. Stannard JP, Harris HW, Volgas DA, Alonso JE. Functional outcome of patients with femoral head fractures associated with hip dislocations. Clin Orthop Relat Res. 2000;377:44–56.

    Article  Google Scholar 

  10. 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;82:679–83.

    Article  CAS  Google Scholar 

  11. Tosounidis T, Aderinto J, Giannoudis PV. Pipkin Type-III fractures of the femoral head: Fix it or replace it? Injury. 2017:2375–8.

    Google Scholar 

  12. Dall D. Exposure of the hip by anterior osteotomy of the greater trochanter: a modified anterolateral approach. J Bone Joint Surg Br. 1986;68-B:382–6.

    Article  Google Scholar 

  13. Herwig-Kempers A, Veraart BE. Reduction of posterior dislocation of the hip in the prone position. J Bone Joint Surg Br. 1993;75(2):328.

    Article  CAS  Google Scholar 

  14. Skoff HD. Posterior hip dislocation, a new technique for reduction. Orthop Rev. 1986;15(6):405–9.

    CAS  PubMed  Google Scholar 

  15. Kurtz WJ, Vrabec GA. Fixation of femoral head fractures using the modified heuter direct anterior approach. J Orthop Trauma. 2009;23(9):675–80. https://doi.org/10.1097/BOT.0b013e3181a14174.

    Article  PubMed  Google Scholar 

  16. Ganz R, et al. 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;83:1119–24.

    Article  CAS  Google Scholar 

  17. Gardner MJ, et al. Surgical dislocation of the hip for fractures of the femoral head. J Orthop Trauma. 2005;19:334–42.

    PubMed  Google Scholar 

  18. Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Relat Res. 1988;230:83–97.

    Google Scholar 

  19. Siebenrock K-A, et al. Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach. J Orthop Trauma. 2006;20:S52–6.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Herman Johal .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Johal, H., Axelrod, D., Bhandari, M. (2020). Femoral Head Fractures. In: Giannoudis, P. (eds) Fracture Reduction and Fixation Techniques. Springer, Cham. https://doi.org/10.1007/978-3-030-24608-2_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-24608-2_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24607-5

  • Online ISBN: 978-3-030-24608-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics