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”’Femoral head fractures”’ are very rare [[bone fracture|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 |
”’Femoral head fractures”’ are very rare [[bone fracture|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. |
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== Signs and Symptoms == |
== Signs and Symptoms == |
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Typical presenting findings include pain in the [[groin]], along with swelling and [[Bruise|bruising]] around the hip.<ref name=”:0″>{{Cite web |title=Hip Fractures – OrthoInfo – AAOS |url=https://www.orthoinfo.org/en/diseases–conditions/hip-fractures/ |access-date=2025-09-11 |website=www.orthoinfo.org}}</ref> Patients are generally unable to walk or bear weight on the affected leg.<ref name=”:0″ /> Femoral head fractures also commonly occur in association with [[Hip dislocation|posterior hip dislocation]].<ref name=”:1″>{{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> In these cases, the affected leg is usually in a [[Anatomical terms of motion|flexed]], [[Anatomical terms of motion|adducted]], and [[Anatomical terms of motion|internally rotated]] position. The affected leg may appear shorter compared to the unaffected leg.<ref name=”:1″ /> [[Sciatic nerve]] injury can also occur, especially in cases of fracture with dislocation.<ref name=”:2″>{{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> |
Typical presenting findings include pain in the [[groin]], along with swelling and [[Bruise|bruising]] around the hip.<ref name=”:0″>{{Cite web |title=Hip Fractures – OrthoInfo – AAOS |url=https://www.orthoinfo.org/en/diseases–conditions/hip-fractures/ |access-date=2025-09-11 |website=www.orthoinfo.org}}</ref> Patients are generally unable to walk or bear weight on the affected leg.<ref name=”:0″ /> Femoral head fractures also commonly occur in association with [[Hip dislocation|posterior hip dislocation]].<ref name=”:1″>{{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> In these cases, the affected leg is usually in a [[Anatomical terms of motion|flexed]], [[Anatomical terms of motion|adducted]], and [[Anatomical terms of motion|internally rotated]] position. The affected leg may appear shorter compared to the unaffected leg.<ref name=”:1″ /> [[Sciatic nerve]] injury can also occur, especially in cases of fracture with dislocation.<ref name=”:2″>{{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> |
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== Diagnosis == |
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=== Imaging === |
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[[Radiography|Plain radiographs]] of the pelvis taken from the front (AP view) are the initial imaging method of choice for isolated injuries.<ref name=”:12″>{{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> Additional views can help identify accompanying injuries, such as [[Acetabular fracture|acetabular fractures]].<ref name=”:12″ /> [[CT scan|CT scans]] are often used in trauma patients with multiple serious injuries or after [[Reduction (orthopedic procedure)|reduction]] to further evaluate the hip joint.<ref name=”:12″ /> [[Magnetic resonance imaging|MRI]] may be used if there is suspected damage to the cartilage of the hip socket or suspected early [[Avascular necrosis|osteonecrosis]].<ref name=”:12″ /> |
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=== Classification === |
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The Pipkin classification is the most frequently used method to categorize femoral head fractures and is organized as follows:<ref>{{Cite journal |last=Romeo |first=Nicholas M. |last2=Firoozabadi |first2=Reza |date=2018-05 |title=Classifications in Brief: The Pipkin Classification of Femoral Head Fractures |url=https://pubmed.ncbi.nlm.nih.gov/29470231 |journal=Clinical Orthopaedics and Related Research |volume=476 |issue=5 |pages=1114–1119 |doi=10.1007/s11999.0000000000000045 |issn=1528-1132 |pmc=5916590 |pmid=29470231}}</ref> |
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| Type I or II fracture with associated [[acetabulum]] fracture |
| Type I or II fracture with associated [[acetabulum]] fracture |
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This classification system helps to guide management and predict outcomes.<ref name=”:12″ /> |
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== See also == |
== See also == |
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Revision as of 19:23, 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]
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.
