Femoral head fractures revisited (analysis of management options approaches and functional outcome)
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:106
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Chinnaswamii K, Dhanasekararaja, Sundararajan, Rajasekaran S
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Introduction: Femoral head fractures present a therapeutic dilemma to the treating surgeon, owing to the absence of established consensus in management of these high energy fractures. Historically in literature, anterior approach to hip has been recommended for fixing these fractures as it is associated with least complications, here we present our experience in managing these fractures primarily using the posterior approach and present our results.
Methods: Forty cases of femoral head fractures with dislocation treated in our institute between 20007 and 2012 were reviewed. Patients were classified according to Pipkins classification system. There were 11 type I, 15 type II, 7 type III and 7 type IV fractures. In Type I fractures, 4 were treated by excision of fragments, 3 patients had internal fixation and 4 were managed conservatively. In type II fractures 10 were internally fixed and four cases underwent Total hip replacement. Type III fractures were managed by THR in 5 cases and internal fixation in two. In Type IV fractures along with acetabular fixation 5 cases had excision of the femoral head fragments and internal fixation in one, one patient had a total hip replacement.
Results: Of the forty cases, five were lost to follow up and in the rest the Functional Outcome was assessed using Harris Hip Score. Average followup being 30.1 months (6- 66 months). We had Excellent results in 18 patients, good in 12 , fair results in 3, and poor results in 2 patients. Fracture union was achieved in all cases that were internally fixed, with posterior approach being the most preferred and was used in fifteen cases undergoing internal fixation or excision, Ganz approach was used in 5 cases. Complications of Avascular necrosis (AVN) was seen in two cases one each for the posterior approach and Ganz approach. Thus the incidence of AVN when posterior approach was used is 6.6% whereas in Ganz approach it is 20% contrary to the belief that posterior approach is associated with increased incidence of AVN.
Conclusion: Management of femoral head fractures though challenging, Internal fixation or excision or primary total hip replacement when performed for the right indication gives acceptable outcomes. Posterior approach to acetabulum gives good exposure to the femoral head fractures and is associated with less incidence of AVN contrary to the available literature.
|How to Cite this Abstract|
|Chinnaswamii K, Dhanasekararaja, Sundararajan, Rajasekaran S. Femoral head fractures revisited (analysis of management options approaches and functional outcome) . International Journal of Conference Proceedings 2015;(2015):106|