Femoral head impaction fracture: a new technique for closed reduction and biological stabilisation

Abstract

Impaction femoral head fractures are seldom diagnosed or treated, even though they can be present in between 39% and 57% of acetabular-fracture dislocations or hip dislocations. These fractures can cause residual hip pain, instability, avascular necrosis (AVN) and early joint wear, potentially necessitating a total hip arthroplasty. Treatment options range from expectant management, which carries a high risk of AVN, to controlled hip dislocation and mosaicplasty, the latter demonstrating variable results. We present the case of a woman in her 50s with an impaction femoral head fracture treated via closed reduction with a bent rod using a predrilled tunnel created with the dynamic hip screw reamer, followed by biological stabilisation with allografts, bone morphogenetic protein-2 and stem cells to provide the appropriate environment for bone healing. This minimally invasive technique offers a viable treatment option for impaction femoral head fractures, with low morbidity and favourable short and mid-term follow-up outcomes. Further studies can validate the results of this technique.