Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures.

Because of the controversy surrounding the selection of the surgical approach for the operative management of femoral head fractures, we retrospectively reviewed the combined experience with femoral head fractures at two major trauma centers. Forty-three femoral head fractures in 41 patients were identified. Twenty-six of the 43 fractures were Pipkin types I and II, and were managed operatively. Of the 26 patients, 12 with > 2 years of follow-up were managed with posterior surgical approaches and 12 with anterior surgical approaches. These patients were assessed with respect to operative time, estimated blood loss and function, and the radiographs for reduction, avascular necrosis, and heterotopic ossification. There was a significant decrease in operative time, estimated blood loss, and improved visualization and fixation with the anterior approach; however, there was a significant increase in functionally significant heterotopic ossification. The functional results in the two groups were identical; 67% good and excellent in each. There were no cases of avascular necrosis of the femoral head associated with an anterior approach. Because of the greater ease of access to the fracture, the anterior approach is recommended when operative reduction of a displaced Pipkin type I or II is indicated, but newer methods of minimizing heterotopic ossification must be developed.