Mei Jiong
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200233, China.
Zhongguo Gu Shang. 2023 Mar 25;36(3):216-21. doi: 10.12200/j.issn.1003-0034.2023.03.004.
Femoral head and ipsilateral femoral neck fractures are serious and complicated injuries, which usually yield unsatisfactory results using conventional hip-preserving surgery. The key point of the management and prognosis mainly lies in femoral neck fractures. An apparent and consecutive relationship exists between femoral neck fractures and femoral head fracture-hip dislocation in such injuries. It is believed that disastrous triad of femoral head (DTFH) could summarize these specific injuries, and reflect the injury mechanism and prognostic characteristics. Based on our clinical observation and literature review, DTFH could be divided into three subgroups:TypeⅠ, common DTFH, in which femoral neck fractures occur following femoral head fractures-hip dislocation due to the same trauma; TypeⅡ, iatrogenic DTFH, in which femoral neck fractures come out in the caring process of femoral head fractures-hip dislocation; Type Ⅲ, stressed DTFH, in which femoral neck fractures occur after the management of femoral head fractures-hip dislocation. In the scenario, the line of femoral neck fractures locates distally to the femoral head fractures. Herein, we will discuss clinical characteristics of these types of DTFH.
股骨头及同侧股骨颈骨折是严重且复杂的损伤，采用传统保髋手术治疗通常效果不佳。治疗及预后的关键主要在于股骨颈骨折。在此类损伤中，股骨颈骨折与股骨头骨折-髋关节脱位之间存在明显且连续的关系。人们认为股骨头灾难性三联征（DTFH）可以概括这些特定损伤，并反映损伤机制和预后特征。基于我们的临床观察和文献回顾，DTFH可分为三个亚组：Ⅰ型，常见DTFH，即由于同一创伤导致股骨头骨折-髋关节脱位后发生股骨颈骨折；Ⅱ型，医源性DTFH，即在股骨头骨折-髋关节脱位的治疗过程中出现股骨颈骨折；Ⅲ型，应激性DTFH，即在股骨头骨折-髋关节脱位治疗后发生股骨颈骨折。在这种情况下，股骨颈骨折线位于股骨头骨折的远侧。在此，我们将讨论这些类型的DTFH的临床特征。
