Femoral head fractures associated with posterior hip dislocations

Abstract

In 13 cases of fractures of the femoral head associated with posterior dislocation of the hip, there were one Type I, 4 Type II, 3 Type III, and 5 Type IV injuries. The results were good in 8, fair in one, and poor in 4. Closed reduction can produce satisfactory early results, but roentgenograms must be carefully examined to detect an occult femoral neck fracture that may be displaced or interfere with a nontraumatic closed reduction. The absolute indications of surgical treatment are: inadequate closed reduction of the hip or femoral head fracture; significant comminution; sciatic nerve injury not present before closed reduction; femoral neck fracture; the involvement of the weight-bearing portion of the femoral head by a single large head fragment. Treatment instituted early can produce a satisfactory result but the prognosis depends upon the degree of injury incurred at the time of the accident and is significantly affected by the presence of an acetabular fracture. The poorest results are associated with: delayed reduction, involvement of the acetabulum, and infection. The maxim of good treatment is immediate reduction. In general, primary open reduction with debridement of the joint and excision of fragments or anatomic reduction of a single large fragment is the procedure of choice. However, circumstances of the injury may dictate that closed reduction be performed immediately because an early, stable, congruous reduction can give good results. Instability or incomplete reduction precludes a good result and is an indication for either: open anatomic reduction of a large single fragment; excision of comminuted, small bone fragments. The goal of treatment is restoration of anatomically perfect and congruous hip joint surfaces.