Kale Dinesh, Kale Sahil, Pratheep Sanjay, Modak Ajit, Bharamgunde Ravindra, Kale Sachin
Department of Orthopedics, K.L.E Dr. Prabhakar Kore Hospital and MRC, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India.
Department of Orthopaedics, Ushahkal Abhinav Institute of Medical Sciences, Sangli, Maharashtra, India.
J Orthop Case Rep. 2025 Sep;15(9):194-198. doi: 10.13107/jocr.2025.v15.i09.6066.
Femoral head fractures occur almost exclusively as a result of a traumatic hip dislocation. Due to the intrinsic anatomical stability of the hip, most of these injuries result from high-energy trauma. Treatment is typically an emergency surgery that includes the reduction of the dislocated hip under anesthesia to fix the fracture of the head of the femur and reduce dislocation. Treatment outcomes tend to be inconsistent, largely because of the fracture's frequent association with pain, joint stiffness, and loss of function. Complications that are most commonly seen after femoral head fractures are osteonecrosis, osteoarthritis, and heterotopic ossification.
A 39-year-old male came to casualty with an alleged history of road traffic accident with multiple fractures in bilateral upper limb, multiple rib fractures, and brachial plexus injury. Computed tomography of the pelvis with both hips was done, which showed a fracture of the left femoral head with a proximal fracture fragment found inside the acetabulum with posterior dislocation of the distal part - left femoral head fracture dislocation (Pipkin type I). Closed reduction of the hip joint failed; hence, open reduction using the Kocher-Langenbeck (KL) approach was carried out, head reduced, transfixed with guide wires, and fixed with three CC screws. On the last follow-up at the end of 1 year, the patient has regained full range of motion of the hip. Patient is able to squat, sit cross-legged, and is able to walk unaided.
The case discussed here is one of its kind, hence fracture was also reduced after reducing the hip joint through trochanterocephalic fixation with KL approach. Precise radiographic pre-operative evaluation and early fixation with early mobilization are the key factors to success in dealing with these complex fractures. Relying on standard and textbook methods may not always yield the best outcome.
股骨头骨折几乎仅由创伤性髋关节脱位引起。由于髋关节固有的解剖稳定性，这些损伤大多由高能创伤导致。治疗通常为急诊手术，包括在麻醉下复位脱位的髋关节以固定股骨头骨折并减少脱位。治疗结果往往不一致，很大程度上是因为骨折常伴有疼痛、关节僵硬和功能丧失。股骨头骨折后最常见的并发症是骨坏死、骨关节炎和异位骨化。
一名39岁男性因据称的道路交通事故前来急诊，双侧上肢多处骨折、多根肋骨骨折及臂丛神经损伤。对骨盆及双髋进行了计算机断层扫描，结果显示左股骨头骨折，髋臼内发现近端骨折碎片，远端部分后脱位——左股骨头骨折脱位（皮普金I型）。髋关节闭合复位失败；因此，采用科克伦 - 朗根贝克（KL）入路进行切开复位，复位股骨头，用导丝固定，并使用3枚CC螺钉固定。在1年末的最后一次随访中，患者已恢复髋关节的全范围活动。患者能够下蹲、盘腿而坐，且能够独立行走。
此处讨论的病例较为独特，因此通过KL入路经转子股骨头固定在复位髋关节后也对骨折进行了复位。精确的术前影像学评估以及早期固定和早期活动是处理这些复杂骨折成功的关键因素。依靠标准和教科书方法未必总能取得最佳结果。
