Management, complications and clinical results of femoral head fractures

Giannoudis, P.V.; Kontakis, G.; Christoforakis, Z.; Akula, M.; Tosounidis, T.; Koutras, C.

doi:10.1016/j.injury.2009.10.024

« Previous Next »Injury
Volume 40, Issue 12 , Pages 1245-1251, December 2009

Management, complications and clinical results of femoral head fractures

P.V. Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
- Corresponding author at: Department of Trauma and Orthopaedics, Academic Unit, Clarendon Wing, Floor A, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK. Tel.: +44 0113 3922750.
G. Kontakis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
- University of Crete, Greece
Z. Christoforakis
- University of Crete, Greece
M. Akula
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
T. Tosounidis
- University of Crete, Greece
C. Koutras
- University of Crete, Greece

Accepted 15 October 2009.

Abstract

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.

Keywords: Femoral fracture, AVN, Infection, Arthritis