Management, complications and clinical results of femoral head fractures.
A systematic review of the literature was conducted to investigate data regarding femoral head fractures, particularly focusing on their management, complications and clinical results. Twenty-nine eligible articles, meeting prespecified inclusion criteria, reported on 453 femoral head fractures in 450 patients (mean age of 38.9 years with a mean follow-up of 55.6 months). 84.3% of patients had been victims of an automobile accident. The most widespread classification scheme used was that of Pipkin (65.4% of cases) whereas clinical results were evaluated mainly according to Thompson-Epstein criteria (63.3% of cases). Fracture-dislocations, in their majority, were managed with emergent closed reduction, followed by definite treatment (closed or open), aiming at anatomic restoration of both fracture and joint incongruity. Regarding Pipkin 1 subtype, fractured fragment excision seems to give better results compared to ORIF (p=0.07), while for the more challenging Pipkin 2 fractures the principles of anatomic reduction and stable fixation should be applied. Wound infection was encountered with a rate of 3.2% of surgical cases and sciatic nerve palsy complicated 3.95% of fracture-dislocations. Major late complications included avascular necrosis (11.9%), post-traumatic arthritis (20%) and heterotopic ossification (16.8%). Neither the trochanteric-flip nor the anterior approach seems to put in more danger the femoral head blood supply compared to the posterior one, with the former giving promising long-term functional results and lower incidence of major complication rates.
Giannoudis
P V
PV
Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. pgiannoudi@aol.com
Kontakis
G
G
Christoforakis
Z
Z
Akula
M
M
Tosounidis
T
T
Koutras
C
C
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D001168:Arthritis / Q000209:etiology; D016206:Databases, Bibliographic; D005260:Female; D005264:Femoral Fractures / Q000145:classification / Q000150:complications / Q000601:surgery; D005270:Femur Head / Q000098:blood supply; D005271:Femur Head Necrosis / Q000209:etiology; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D006617:Hip Dislocation / Q000145:classification / Q000150:complications / Q000628:therapy; D006801:Humans; D008297:Male; D009999:Ossification, Heterotopic / Q000209:etiology; D020127:Recovery of Function; D020426:Sciatic Neuropathy / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome