Giannoudis Peter V, Gonzalez Edery Eduardo, Nemade Pradip, Bagaria Vaibhav
Academic Department of Trauma and Orthopaedic Surgery, Univ Leeds, Leeds, UK
Trauma and Orthopaedic Surgery, University of Leeds, Leeds, UK.
BMJ Case Rep. 2025 Mar 31;18(3):e264269. doi: 10.1136/bcr-2024-264269.
Impaction femoral head fractures are seldom diagnosed or treated, even though they can be present in between 39% and 57% of acetabular-fracture dislocations or hip dislocations. These fractures can cause residual hip pain, instability, avascular necrosis (AVN) and early joint wear, potentially necessitating a total hip arthroplasty. Treatment options range from expectant management, which carries a high risk of AVN, to controlled hip dislocation and mosaicplasty, the latter demonstrating variable results.We present the case of a woman in her 50s with an impaction femoral head fracture treated via closed reduction with a bent rod using a predrilled tunnel created with the dynamic hip screw reamer, followed by biological stabilisation with allografts, bone morphogenetic protein-2 and stem cells to provide the appropriate environment for bone healing. This minimally invasive technique offers a viable treatment option for impaction femoral head fractures, with low morbidity and favourable short and mid-term follow-up outcomes. Further studies can validate the results of this technique.
股骨头嵌插骨折很少得到诊断或治疗，尽管在髋臼骨折脱位或髋关节脱位中，其发生率可达39%至57%。这些骨折可导致残留髋关节疼痛、不稳定、缺血性坏死（AVN）和早期关节磨损，可能需要进行全髋关节置换术。治疗选择范围从有较高AVN风险的保守治疗，到控制性髋关节脱位和镶嵌成形术，后者的效果不一。我们报告了一例50多岁女性股骨头嵌插骨折的病例，通过使用动力髋螺钉扩孔钻创建的预钻孔隧道，用弯棒进行闭合复位治疗，随后用同种异体骨、骨形态发生蛋白-2和干细胞进行生物稳定，以提供适合骨愈合的环境。这种微创技术为股骨头嵌插骨折提供了一种可行的治疗选择，具有低发病率以及良好的短期和中期随访结果。进一步的研究可以验证该技术的结果。
