Management and Outcome of Patients With Femoral Head Fractures: Injuries and Associated Prognostic Factors

Objective: Femoral head fractures are rare injuries that are often associated with poor functional outcome and complications. Fracture management and surgical methods for these fractures are variable. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications and functional outcomes of femoral head fractures.Methods: We conducted a retrospective review of fifty patients who sustained femoral head fractures from January 2011- December 2018. There were thirty-seven males and thirteen females with median age of 40 years. A surgical approach and fixation method were recorded. Patients were classified according to the Pipkin Classification system. Clinical results were evaluated for patients with two years or greater follow-up using the Modified Harris Hip Score (MHHS). Results: Eight patients (16%) were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, 5 (10%) patients required immediate Total Hip Replacement (THR). Six (12%) developed AVN, four (8%) requiring secondary total hip replacement (THR). Sixteen patients (33%) developed PTA, eight (16%) developed HO and six patients (12 %) had sciatic nerve injury, none requiring operative treatment. Overall functional results, according to modified Harris hip score were excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. A statistically significant difference in outcome was observed among four pipkin subtypes. Conclusion: Femoral head fracture are a rare injury that are often associated with poor outcome. In this study we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on Pipkin classification. This study, adds to the growing literature on femoral head fractures and provide reference for the clinical treatment to guide patient management.

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