Skip to main content
SpringerLink
Log in

Femoral head fractures

  • Trauma (MJ Gardner, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Femoral head fractures may present in various patterns with or without associated fractures around the hip. As a result, the treating orthopaedic surgeon must understand not only the fracture pattern, but also patient-related fractures and the relevant operative exposures and reconstructive options to achieve the best functional outcome while minimizing complications. Treatment options range from non-operative treatment to fracture fragment excision or fracture fixation using various surgical exposures and implants. This article reviews the current literature on the treatment options for femoral head fractures and presents modern operative techniques that have improved exposure of the fracture while minimizing associated risks such as avascular necrosis, heterotopic ossification, and neurovascular compromise. A sound understanding of the anatomy and these newer techniques can enable the surgeon to provide improved expectations and clinical outcomes.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Hougaard K, Thomsen PR. Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head. J Bone Joint Surg Am. 1988;70:233–9.

    PubMed  CAS  Google Scholar 

  2. Roeder LF, DeLee JC. Femoral head fractures associated with posterior hip dislocation. Clin Orthop Relat Res. 1980;147:121–30.

    PubMed  Google Scholar 

  3. Sahin V, Karakas ES, Aksu S, et al. Traumatic dislocation and fracture-dislocation of the hip. A long-term follow-up study. J Trauma. 2003;54:520–9.

    Article  PubMed  Google Scholar 

  4. Birkett J. Description of a dislocation of the head of the femur complicated with its fracture. With remarks. Med Chir Trans. 1869;52:133.

    PubMed  CAS  Google Scholar 

  5. Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop Relat Res. 1985;201:9–17.

    PubMed  Google Scholar 

  6. Thompson VP, Epstein HC. Traumatic dislocation of the hip: a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg Am. 1951;33:746–78.

    PubMed  Google Scholar 

  7. Davis JB. Simultaneous femoral head fracture and traumatic hip dislocation. Am J Surg. 1950;80:893–5.

    Article  PubMed  CAS  Google Scholar 

  8. Rosenthal RE, Coker WL. Posterior fracture-dislocation of hip: an epidemiologic review. J Trauma. 1979;19:572–81.

    Article  PubMed  CAS  Google Scholar 

  9. Epstein HC. Posterior fracture-dislocations of the hip: long-term follow-up. J Bone Joint Surg Am. 1974;56:1103–27.

    PubMed  CAS  Google Scholar 

  10. Funsten RV, Kinser P, Frankel CJ. Dashboard dislocation of the hip: a report of twenty cases of traumatic dislocation. J Bone Joint Surg Am. 1938;20:124–32.

    Google Scholar 

  11. Moed BR, Maxey JW. Evaluation of fractures of the femoral head using the CT-directed pelvic oblique radiograph. Clin Orthop Relat Res. 1993;296:161–7.

    PubMed  Google Scholar 

  12. Pipkin G. Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am. 1957;39:1027–42.

    PubMed  Google Scholar 

  13. Brumback RJ, Kenzora JE, Levitt LE, et al. Fractures of the femoral head. Hip 1987; 181–206.

  14. 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 fractures. J Orthop Trauma. 1992;6:437–42.

    Article  PubMed  CAS  Google Scholar 

  15. Kloen P, Siebenrock KA, Raaymaers E, et al. Femoral head fractures revisited. Eur J Trauma. 2002;28:221–33.

    Article  Google Scholar 

  16. Butler JE. Pipkin type-II fractures of the femoral head. JBJS. 1981;63:1292–6.

    CAS  Google Scholar 

  17. Gardner M, Suk M, Pearle A, et al. Surgical dislocation of the hip from fractures of the femoral head. J Orthop Trauma. 2005;19:334–42.

    PubMed  Google Scholar 

  18. Epstein HC. Traumatic dislocations of the hip. Clin Orthop Relat Res. 1973;92:116–42.

    Article  PubMed  Google Scholar 

  19. Gautier E, Ganz K, Krugel N, et al. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82:679–83.

    Article  PubMed  CAS  Google Scholar 

  20. 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  PubMed  Google Scholar 

  21. Nork SE and Routt Jr MLC. Personal communication.

  22. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip: a technique with full access to the femoral head and acetabulum without risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–24.

    Article  PubMed  CAS  Google Scholar 

  23. Bastian JD, Wolf AT, Wyss TF, Notzli HP. Stepped osteotomy of the trochanter for stable, anatomic refixation. Clin Orthop Relat Res. 2009;467:732–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  26. Byrd JW. Hip arthroscopy. J Am Acad Orthop Surg. 2006;14:433–44.

    PubMed  Google Scholar 

  27. Clarke MT, Arora A, Villar RN. Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res. 2003;406:84–8.

    Article  PubMed  Google Scholar 

  28. Verma M, Sekiya JK. Intrathoracic fluid extravasation after hip arthroscopy. Artrosc. 2010;26(9 Suppl):S90–94.

    Article  Google Scholar 

  29. Ladner B, Nester K, Cascio B. Abdominal fluid extravastion during hip arthroscopy. Artrosc. 2010;26(1):131–5.

    Article  Google Scholar 

  30. Fowler J, Owens BD. Adominal compartment syndrome after hip arthroscopy. Artrosc. 2010;26(1):128–30.

    Article  Google Scholar 

  31. Bartlett CS, DiFelice GS, Buly RL, et al. Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture. J Orthop Trauma. 1998;12:294–9.

    Article  PubMed  CAS  Google Scholar 

  32. Marchetti ME, Steinberg GG, Coumas JM. Intermediate term experience of pipkin facture dislocations of the hip. J Orthop Trauma. 1996;10:455–61.

    Article  PubMed  CAS  Google Scholar 

  33. • Chen Z, Lin B, Zhai W, et al. Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomized control trial. Int Orthop 2011; 35: 1077–1081. Patients with Pipkin type 1 fractures were randomly divided to two groups: conservative treatment with closed reduction or surgical treatment with fragment excision. Functional outcome scores of the conservative group was worse than the operative excision group.

    Article  PubMed  Google Scholar 

  34. Holmes WJ, Solberg B, Bay BK, et al. Biomechanical consequences of excision of displaced Pipkin femoral head fractures. J Orthop Trauma. 2000;14(2):149–50.

    Article  Google Scholar 

  35. Mostafa MM. Femoral head fracures. Int Orthop. 2001;25:51–4.

    Article  PubMed  CAS  Google Scholar 

  36. Lange RH, Engber WD, Clancy WG. Expanding applications for the Herbert scaphoid screw. Orthop. 1986;9:1393–7.

    CAS  Google Scholar 

  37. Murray P, McGee HM, Mulvihill N. Fixation of femoral head fractures using the Herbert screw. Inj. 1988;19:220–1.

    Article  CAS  Google Scholar 

  38. Jukkala-Partio K. Partio EK, Hirvensalo E. Rokkanen P. Absorbable fixation of femoral head fractures. A prospective study of six cases. Ann Chir Gynaecol. 1998;87(1):44–8.

    PubMed  CAS  Google Scholar 

  39. Wright RD, Routt Jr MLCR. Femoral Head Fractures. In: Gardner MJ, Henley MB, editors. Harborview Illustrated Tips and Tricks in Fracture Surgery. Philadelphia: Lippincott Williams & Wilkins; 2011.

    Google Scholar 

Download references

Disclosure

JR Ross: none; MJ Gardner: consultant to Synthes, Stryker, Amgen, DGI Med, RTI Biologics.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110, USA

    James R. Ross & Michael J. Gardner

Authors
  1. James R. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael J. Gardner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James R. Ross.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ross, J.R., Gardner, M.J. Femoral head fractures. Curr Rev Musculoskelet Med 5, 199–205 (2012). https://doi.org/10.1007/s12178-012-9129-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-012-9129-8

Keywords

Search

Navigation