Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2020 Oct;43(5):451-457. doi: 10.1016/j.bj.2019.08.004. Epub 2020 Sep 30.
Femoral head fractures (FHF) are uncommon and generally caused by high-energy injuries. Surgical reduction with stable fixation of large fragments is believed to have the best outcomes. This retrospective study intended to report outcomes with surgical treatment at our institution and tried to establish treatment algorithm.
Through the 6-year period (2003-2008), 35 FHF in 35 consecutive patients (average, 30 years) were surgically treated. All FHF were caused by high-energy trauma. Patients' general condition was stabilized first and hip dislocation was manually reduced immediately. Definite fracture treatment was scheduled after admission for an average of 2.9 days (0.3-11 days). Pipkin classification was used as the treatment guide and open reduction with internal fixation was performed in all 35 FHF.
These FHF included 21 type I, 7 type II, 3 type III, and 4 type IV fractures. The hip joint had been approached by either an anterior or posterior route depending on the individual surgeon. Internal fixation with screws was performed for all 35 FHF. The average admission was 13.8 days (range, 2-35 days). Thirty patients (86%, 30/35) were followed for an average of 3.3 years (at lease 6 months) and all 30 FHF healed. Avascular necrosis of the femoral head was found in 23% (7/30) patients and six patients were converted to hip arthroplasty for developing advanced stages of avascular necrosis. Heterotopic ossification occurred in 43% (13/30) patients. However, only one patient had range of motion limitation. Besides, one patient had moderate hip osteoarthritis.
FHF are uncommon and generally caused by high-energy injuries. Fracture healing can be attained in all femoral head fractures by using open reduction and screw fixation. Our results by using conventional approaches were associated with high complication rates. Further endeavor to improve the outcome should be taken.
股骨颈骨折（FHF）并不常见，通常由高能损伤引起。大碎片的手术复位和稳定固定被认为具有最佳的结果。本回顾性研究旨在报告我院手术治疗的结果，并尝试建立治疗方案。
在 6 年期间（2003-2008 年），对 35 名连续患者（平均 30 岁）的 35 例 FHF 进行了手术治疗。所有 FHF 均由高能创伤引起。首先稳定患者的一般状况，并立即手动复位髋关节脱位。在入院后平均 2.9 天（0.3-11 天）确定骨折治疗方案。采用 Pipkin 分类作为治疗指南，所有 35 例 FHF 均行切开复位内固定。
这些 FHF 包括 21 例 I 型、7 例 II 型、3 例 III 型和 4 例 IV 型骨折。根据术者的不同，髋关节采用前或后入路。所有 35 例 FHF 均采用螺钉内固定。平均入院时间为 13.8 天（范围为 2-35 天）。30 例（86%，30/35）患者平均随访 3.3 年（至少 6 个月），所有 30 例 FHF 均愈合。23%（7/30）的患者发现股骨头缺血性坏死，6 例患者因进展为缺血性坏死晚期而转为髋关节置换术。异位骨化发生率为 43%（13/30）。然而，仅有 1 例患者活动度受限。此外，1 例患者出现中度髋关节骨关节炎。
FHF 并不常见，通常由高能损伤引起。通过切开复位和螺钉固定可使所有股骨头骨折愈合。我们采用传统方法的结果与高并发症发生率相关。应进一步努力改善结果。
