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== Prognosis == |
== Prognosis == |
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There are multiple scoring systems used to assess outcomes following recovery, including the Thompson and Epstein outcome score, Merle d’Aubigné and Postel score, and the [[Oxford Hip Score]].<ref name=”:23″>{{Cite journal |last=Schaffer |first=Nathaniel E. |last2=Luther |first2=Lauren |last3=Tatman |first3=Lauren M. |last4=Mitchell |first4=Phillip M. |date=2024-10-15 |title=Femoral Head Fractures: Evaluation, Management, and Outcomes |url=https://pubmed.ncbi.nlm.nih.gov/38968607 |journal=The Journal of the American Academy of Orthopaedic Surgeons |volume=32 |issue=20 |pages=929–937 |doi=10.5435/JAAOS-D-23-01121 |issn=1940-5480 |pmid=38968607}}</ref> Using these scoring systems, good to excellent outcomes are achieved in about two-thirds of cases.<ref name=”:23″ /> However, the association of the injury with pain, [[joint stiffness]], and loss of function contributes to variability in treatment outcomes.<ref name=”:32″>{{Cite journal |last=Giordano |first=Vincenzo |last2=Giordano |first2=Marcos |last3=Glória |first3=Renato Caravellos |last4=de Souza |first4=Felipe Serrão |last5=di Tullio |first5=Paulo |last6=Lages |first6=Marco Martins |last7=Koch |first7=Hilton Augusto |date=2019 |title=General principles for treatment of femoral head fractures |url=https://pubmed.ncbi.nlm.nih.gov/30705552 |journal=Journal of Clinical Orthopaedics and Trauma |volume=10 |issue=1 |pages=155–160 |doi=10.1016/j.jcot.2017.07.013 |issn=0976-5662 |pmc=6349681 |pmid=30705552}}</ref> Common long-term complications include [[Post-traumatic arthritis|posttraumatic arthritis]], osteonecrosis of the femoral head, and [[heterotopic ossification]].<ref name=”:23″ /> |
There are multiple scoring systems used to assess outcomes following recovery, including the Thompson and Epstein outcome score, Merle d’Aubigné and Postel score, and the [[Oxford Hip Score]].<ref name=”:23″>{{Cite journal |last=Schaffer |first=Nathaniel E. |last2=Luther |first2=Lauren |last3=Tatman |first3=Lauren M. |last4=Mitchell |first4=Phillip M. |date=2024-10-15 |title=Femoral Head Fractures: Evaluation, Management, and Outcomes |url=https://pubmed.ncbi.nlm.nih.gov/38968607 |journal=The Journal of the American Academy of Orthopaedic Surgeons |volume=32 |issue=20 |pages=929–937 |doi=10.5435/JAAOS-D-23-01121 |issn=1940-5480 |pmid=38968607}}</ref> Using these scoring systems, good to excellent outcomes are achieved in about two-thirds of cases.<ref name=”:23″ /> However, the association of the injury with pain, [[joint stiffness]], and loss of function contributes to variability in treatment outcomes.<ref name=”:32″>{{Cite journal |last=Giordano |first=Vincenzo |last2=Giordano |first2=Marcos |last3=Glória |first3=Renato Caravellos |last4=de Souza |first4=Felipe Serrão |last5=di Tullio |first5=Paulo |last6=Lages |first6=Marco Martins |last7=Koch |first7=Hilton Augusto |date=2019 |title=General principles for treatment of femoral head fractures |url=https://pubmed.ncbi.nlm.nih.gov/30705552 |journal=Journal of Clinical Orthopaedics and Trauma |volume=10 |issue=1 |pages=155–160 |doi=10.1016/j.jcot.2017.07.013 |issn=0976-5662 |pmc=6349681 |pmid=30705552}}</ref> Common long-term complications include [[Post-traumatic arthritis|posttraumatic arthritis]], osteonecrosis of the femoral head, and [[heterotopic ossification]].<ref name=”:23″ /> |
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== Epidemiology == |
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Although still uncommon, the incidence of femoral head fractures has increased in recent times.<ref name=”:13″>{{Cite journal |last=Menger |first=Maximilian M. |last2=Braun |first2=Benedikt J. |last3=Herath |first3=Steven C. |last4=Küper |first4=Markus A. |last5=Rollmann |first5=Mika F. |last6=Histing |first6=Tina |date=2021-11 |title=Fractures of the femoral head: a narrative review |url=https://pubmed.ncbi.nlm.nih.gov/34909230 |journal=EFORT open reviews |volume=6 |issue=11 |pages=1122–1131 |doi=10.1302/2058-5241.6.210034 |issn=2058-5241 |pmc=8631236 |pmid=34909230}}</ref> This trend is thought to be the result of two main factors: an increase in motor vehicle accidents and advances in modern vehicle safety, which have increased survival and allowed for more frequent identification of these fractures.<ref name=”:13″ /> |
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== See also == |
== See also == |
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Revision as of 19:27, 21 September 2025
Femoral head fractures are very rare fractures of the upper end (femoral head) of the thigh bone (femur). They are a very rare kind of hip fracture that may be the result of a fall like most hip fractures but are more commonly caused by more violent incidents such as traffic accidents.
Signs and Symptoms
Typical presenting findings include pain in the groin, along with swelling and bruising around the hip.[1] Patients are generally unable to walk or bear weight on the affected leg.[1] Femoral head fractures also commonly occur in association with posterior hip dislocation.[2] In these cases, the affected leg is usually in a flexed, adducted, and internally rotated position. The affected leg may appear shorter compared to the unaffected leg.[2] Sciatic nerve injury can also occur, especially in cases of fracture with dislocation.[3]
Diagnosis
Imaging
Plain radiographs of the pelvis taken from the front (AP view) are the initial imaging method of choice for isolated injuries.[4] Additional views can help identify accompanying injuries, such as acetabular fractures.[4] CT scans are often used in trauma patients with multiple serious injuries or after reduction to further evaluate the hip joint.[4] MRI may be used if there is suspected damage to the cartilage of the hip socket or suspected early osteonecrosis.[4]
Classification
The Pipkin classification is the most frequently used method to categorize femoral head fractures and is organized as follows:[5]
| Pipkin classification type | Description |
|---|---|
| I | Fracture below the fovea; not involving weight-bearing surface of the head |
| II | Fracture above the fovea; involving weight-bearing surface of the head |
| III | Type I or II fracture with associated femoral neck fracture |
| IV | Type I or II fracture with associated acetabulum fracture |
This classification system helps to guide management and predict outcomes.[4]
Treatment
Initial physical examination should include assessment of circulation and nerve function in the affected leg, particularly in the distribution of the sciatic nerve.[6] In cases with hip dislocation, urgent reduction is required, with earlier intervention being predictive of a better outcome.[7] Definitive management in younger patients may involve surgical options such as open reduction and internal fixation or fragment removal.[7] In contrast, total hip replacement is generally favored in elderly patients.[7]
Prognosis
There are multiple scoring systems used to assess outcomes following recovery, including the Thompson and Epstein outcome score, Merle d’Aubigné and Postel score, and the Oxford Hip Score.[8] Using these scoring systems, good to excellent outcomes are achieved in about two-thirds of cases.[8] However, the association of the injury with pain, joint stiffness, and loss of function contributes to variability in treatment outcomes.[9] Common long-term complications include posttraumatic arthritis, osteonecrosis of the femoral head, and heterotopic ossification.[8]
Epidemiology
Although still uncommon, the incidence of femoral head fractures has increased in recent times.[10] This trend is thought to be the result of two main factors: an increase in motor vehicle accidents and advances in modern vehicle safety, which have increased survival and allowed for more frequent identification of these fractures.[10]
See also
References
- ^ a b “Hip Fractures – OrthoInfo – AAOS”. www.orthoinfo.org. Retrieved 2025-09-11.
- ^ a b Menger, Maximilian M.; Braun, Benedikt J.; Herath, Steven C.; Küper, Markus A.; Rollmann, Mika F.; Histing, Tina (2021-11). “Fractures of the femoral head: a narrative review”. EFORT open reviews. 6 (11): 1122–1131. doi:10.1302/2058-5241.6.210034. ISSN 2058-5241. PMC 8631236. PMID 34909230.
- ^ Schaffer, Nathaniel E.; Luther, Lauren; Tatman, Lauren M.; Mitchell, Phillip M. (2024-10-15). “Femoral Head Fractures: Evaluation, Management, and Outcomes”. The Journal of the American Academy of Orthopaedic Surgeons. 32 (20): 929–937. doi:10.5435/JAAOS-D-23-01121. ISSN 1940-5480. PMID 38968607.
- ^ a b c d e Menger, Maximilian M.; Braun, Benedikt J.; Herath, Steven C.; Küper, Markus A.; Rollmann, Mika F.; Histing, Tina (2021-11). “Fractures of the femoral head: a narrative review”. EFORT open reviews. 6 (11): 1122–1131. doi:10.1302/2058-5241.6.210034. ISSN 2058-5241. PMC 8631236. PMID 34909230.
- ^ Romeo, Nicholas M.; Firoozabadi, Reza (2018-05). “Classifications in Brief: The Pipkin Classification of Femoral Head Fractures”. Clinical Orthopaedics and Related Research. 476 (5): 1114–1119. doi:10.1007/s11999.0000000000000045. ISSN 1528-1132. PMC 5916590. PMID 29470231.
- ^ Schaffer, Nathaniel E.; Luther, Lauren; Tatman, Lauren M.; Mitchell, Phillip M. (2024-10-15). “Femoral Head Fractures: Evaluation, Management, and Outcomes”. The Journal of the American Academy of Orthopaedic Surgeons. 32 (20): 929–937. doi:10.5435/JAAOS-D-23-01121. ISSN 1940-5480. PMID 38968607.
- ^ a b c Giordano, Vincenzo; Giordano, Marcos; Glória, Renato Caravellos; de Souza, Felipe Serrão; di Tullio, Paulo; Lages, Marco Martins; Koch, Hilton Augusto (2019). “General principles for treatment of femoral head fractures”. Journal of Clinical Orthopaedics and Trauma. 10 (1): 155–160. doi:10.1016/j.jcot.2017.07.013. ISSN 0976-5662. PMC 6349681. PMID 30705552.
- ^ a b c Schaffer, Nathaniel E.; Luther, Lauren; Tatman, Lauren M.; Mitchell, Phillip M. (2024-10-15). “Femoral Head Fractures: Evaluation, Management, and Outcomes”. The Journal of the American Academy of Orthopaedic Surgeons. 32 (20): 929–937. doi:10.5435/JAAOS-D-23-01121. ISSN 1940-5480. PMID 38968607.
- ^ Giordano, Vincenzo; Giordano, Marcos; Glória, Renato Caravellos; de Souza, Felipe Serrão; di Tullio, Paulo; Lages, Marco Martins; Koch, Hilton Augusto (2019). “General principles for treatment of femoral head fractures”. Journal of Clinical Orthopaedics and Trauma. 10 (1): 155–160. doi:10.1016/j.jcot.2017.07.013. ISSN 0976-5662. PMC 6349681. PMID 30705552.
- ^ a b Menger, Maximilian M.; Braun, Benedikt J.; Herath, Steven C.; Küper, Markus A.; Rollmann, Mika F.; Histing, Tina (2021-11). “Fractures of the femoral head: a narrative review”. EFORT open reviews. 6 (11): 1122–1131. doi:10.1302/2058-5241.6.210034. ISSN 2058-5241. PMC 8631236. PMID 34909230.
