[Indentation fractures of the femoral head complicating the traumatic dislocation of the hip. Treatment by intertrochanteric osteotomy].

INTRODUCTION

Indentation fractures of the femoral head, are known to be rare with poor long-term prognosis. This study aimed to demonstrate that intertrochanteric osteotomy allowed improvement of late outcome after indentation fractures of the femoral head.

PATIENTS AND METHODS

Between 1980 and 1984, four patients with a femoral head fracture after traumatic hip dislocation were treated by intertrochanteric osteotomy. The mean age at time of surgery was 24 years. The injury was a traffic accident in 2 out of 4 cases. All of four had indentation fractures of the left femoral head. All patients underwent immediate reduction of the dislocation. The intertrochanteric osteotomy, was delayed between 1 months to 3 years. Four Müller's osteotomies and one Sugioka's osteotomy were performed. One patient had 2 successive procedures. Mean pre-operative Merle d'Aubigne score was 13.5. In this retrospective study, results were assessed according to Merle d'Aubigne score and Epstein clinical and radiological method.

RESULTS

Mean follow-up was 9 years (7 to 12). Three patients had a good result and one had two successive poor results in the same hip. Mean last follow-up Merle's score was 16.3 (15 to 18). The only poor result occurred because of late femoral head necrosis, in one hip with 2 successive osteotomies.

DISCUSSION

As indentation fractures occurred in the upper part of the femoral head, the goal of the osteotomy was to displace the impacted articular surface out of the weight-bearing area. The prognosis of such lesions was usually poor, because in previously reported series, patients received no treatment. In our experience, intertrochanteric osteotomy could be proposed as an efficient therapy in femoral head indentation fractures.