Background
Fracture of the femoral head is a relatively rare injury, which is often associated with a poor functional outcome. The treatment of femoral head fractures is a controversial subject in many respects.
Patients and methods
Ten patients with a fracture dislocation of the hip were admitted to the Zagazig University Hospital. Each fracture type was classified according to the Pipkin classification; six of the ten patients had a Pipkin Type II, two patients had a Pipkin Type I, and two patients had a Pipkin Type III fracture. All the fractures were associated with a posterior dislocation. There were no instances of damage of the sciatic nerve. The average age of the patients at the time of injury was 37 years (range 27-66 years). The vast majority (six patients) sustained the injury in a car accident. The anterior approach was used in all the cases. Outcome was assessed on the basis of physical and radiographic evaluation, in addition to the Merle d'Aubigne and Postel and the Thompson and Epstein scores.
Results
Follow-up of at least 2 years was available for all patients (average follow-up 64 months, range 24-55 months). The overall outcome, irrespective of the fracture type or treatment, was excellent/good in 50%, fair in 30%, and poor in 20%.
Complications
There were four post-traumatic (presurgical) sciatic nerve injuries; they recovered almost completely. There were no surgical nerve injuries. One patient developed (Brooker I) heterotopic ossification. Two cases of avascular necrosis were seen; one of these had an unreduced fracture dislocation for 7 days.
Conclusion
We believe that newer techniques and approaches allow us to improve the outcome of femoral head fractures. Anatomic reduction leading to a perfectly congruent joint is the goal of treatment. Careful evaluation of the reduction (preoperatively and postoperatively) using computed tomography scan is mandatory. When surgery is required, it is very important to use an approach that provides an excellent view of and access to the fracture, thus allowing perfect anatomic reduction and fixation.