Fractures of the femoral head: a narrative review

Abstract

Fractures of the femoral head are rare injuries, which typically occur after posterior hip dislocation. The Pipkin classification, developed in 1957, is the most commonly used classification scheme to date. The injury is mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a significant height. Emergency treatment consists of urgent closed reduction of the hip joint, followed by non-operative or operative treatment of the femoral head fracture and any associated injuries. There is an ongoing controversy about the suitable surgical approach (anterior vs. posterior) for addressing fractures of the femoral head. Fracture location, degree of displacement, joint congruity and the presence of loose fragments, as well as concomitant injuries are crucial factors in choosing the adequate surgical approach. Long-term complications such as osteonecrosis of the femoral head, posttraumatic osteoarthritis and heterotopic ossification can lead to a relatively poor functional outcome. Cite this article: EFORT Open Rev 2021;6:1122-1131. DOI: 10.1302/2058-5241.6.210034

Fractured morphology of femoral head associated with subsequent femoral neck fracture: Injury analyses of 2D and 3D models of femoral head fractures with computed tomography

“…The major choice of surgical FHF treatment was reduction and internal fixation, or fragment removal, while joint replacement surgeries were favored for some FHF patients due to the presence of the ipsilateral femoral neck fracture (FNF) (Menger et al, 2021). The ipsilateral FNF had an incidence of 8.6% and the worst prognosis among all FHFs (Menger et al, 2021Giannoudis et al, 2009. There were many possible scenarios, simultaneously with FHF by trauma, during reduction, during an eventual FHF fixation, upon resumption of the weight bearing, etc., for the occurrence of the ipsilateral FNF.…”

Safety of surgical hip dislocation in femoral head fracture and dislocation (FHFD) and avascular necrosis risk factor analysis of FHFD: midterm results confirmed by SPECT/CT and MRI

“…The prognosis of these fractures depends on the accuracy of the reduction and stability of fixation. Traumatic hip dislocation accompanied by femoral head fracture is frequently associated with damage to other organs and combined fractures and may cause complications, such as avascular necrosis (AVN) of the femoral head, traumatic arthritis, and heterotopic ossification (HO) [ 2 , 3 ]. Therefore, prompt and accurate treatment in the early stage of the injury and continuous follow-up are required [ 4 , 5 ].…”

An open reduction and internal fixation of a Pipkin type 1 fracture: A case report

“…Pipkins fractures are articular fractures of femoral head that are mainly caused by high-energy traumas like motor vehicle accidents (dashboard injury), sport injuries or falls from heights with an incidence of 2 cases per million [ 1 , 2 ]. These fractures are considered to be rarely encountered.…”

“…These fractures are considered to be rarely encountered. However, this occurrence rate is increasing simultaneously with the higher incidence of road traffic accidents currently [ 1 , 2 ]. Since these fractures were described for the first time in 1869, multiple classification systems have emerged.…”

“…Pipkin classified these injuries into 4 types. Type 1 involves fracture inferior to the capitis femoris (the non-weight bearing part of femoral head) [ 1 , 2 ]. Radiology is the cornerstone to an appropriate assessment.…”