Femoral head fractures: anatomy, diagnosis and management.

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Abstract

Conflict of interest statement: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the work reported. 8. Injury. 2009 Dec;40(12):1245-51. doi: 10.1016/j.injury.2009.10.024. Epub 2009 Nov 7. Management, complications and clinical results of femoral head fractures. Giannoudis PV(1), Kontakis G, Christoforakis Z, Akula M, Tosounidis T, Koutras C. Author information: (1)Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. pgiannoudi@aol.com A systematic review of the literature was conducted to investigate data regarding femoral head fractures, particularly focusing on their management, complications and clinical results. Twenty-nine eligible articles, meeting prespecified inclusion criteria, reported on 453 femoral head fractures in 450 patients (mean age of 38.9 years with a mean follow-up of 55.6 months). 84.3% of patients had been victims of an automobile accident. The most widespread classification scheme used was that of Pipkin (65.4% of cases) whereas clinical results were evaluated mainly according to Thompson-Epstein criteria (63.3% of cases). Fracture-dislocations, in their majority, were managed with emergent closed reduction, followed by definite treatment (closed or open), aiming at anatomic restoration of both fracture and joint incongruity. Regarding Pipkin 1 subtype, fractured fragment excision seems to give better results compared to ORIF (p=0.07), while for the more challenging Pipkin 2 fractures the principles of anatomic reduction and stable fixation should be applied. Wound infection was encountered with a rate of 3.2% of surgical cases and sciatic nerve palsy complicated 3.95% of fracture-dislocations. Major late complications included avascular necrosis (11.9%), post-traumatic arthritis (20%) and heterotopic ossification (16.8%). Neither the trochanteric-flip nor the anterior approach seems to put in more danger the femoral head blood supply compared to the posterior one, with the former giving promising long-term functional results and lower incidence of major complication rates. DOI: 10.1016/j.injury.2009.10.024