Afemoral head fracture is a rare type ofhip fracture that involves a break in the rounded portion of the thigh bone (femur) that fits into the hip socket.[1] They are estimated to account for less than 1% of all hip fractures, with two-thirds of those affected being young adults.[1][2] These injuries are typically sustained during high-impact events, such as car accidents or falls from significant heights.[2]
Typical presenting findings include pain in thegroin, along with swelling andbruising around the hip.[1] Patients are generally unable to walk or bear weight on the affected leg.[1] Femoral head fractures also commonly occur in association withposterior hip dislocation.[2] In these cases, the affected leg is usually in aflexed,adducted, andinternally rotated position. The affected leg may appear shorter compared to the unaffected leg.[2]Sciatic nerve injury can also occur, especially in cases of fracture with dislocation.[3] This may manifest with absent or diminished reflexes and weakness when bending the knee or moving the foot.[4]
Plain radiographs of the pelvis taken from the front (AP view) are the initial imaging method of choice for isolated injuries.[2] Additional views can help identify accompanying injuries, such asacetabular fractures.[2]CT scans are often used in trauma patients with multiple serious injuries or afterreduction to further evaluate the hip joint.[2]MRI may be used if there is suspected damage to the cartilage of the hip socket or suspected earlyosteonecrosis.[2]
The Pipkin classification is the most frequently used method to categorize femoral head fractures and is organized as follows:[5]
| Pipkin classification type | Description |
|---|---|
| I | Fracture below thefovea; not involving weight-bearing surface of the head |
| II | Fracture above thefovea; involving weight-bearing surface of the head |
| III | Type I or II fracture with associatedfemoral neck fracture |
| IV | Type I or II fracture with associatedacetabulum fracture |
This classification system helps to guide management and predict outcomes.[2]
Initial physical examination should include assessment of circulation and nerve function in the affected leg, particularly in the distribution of the sciatic nerve.[3] In cases with hip dislocation, urgent reduction is required, with earlier intervention being predictive of a better outcome.[6] Definitive management in younger patients may involve surgical options such asopen reduction and internal fixation or fragment removal.[6] In contrast,total hip replacement is generally favored in elderly patients.[6]
There are multiple scoring systems used to assess outcomes following recovery, including the Thompson and Epstein outcome score, Merle d'Aubigné and Postel score, and theOxford Hip Score.[3] Using these scoring systems, good to excellent outcomes are achieved in about two-thirds of cases.[3] However, the association of the injury with pain,joint stiffness, and loss of function contributes to variability in treatment outcomes.[6] Common long-term complications includeposttraumatic arthritis, osteonecrosis of the femoral head, andheterotopic ossification.[3]
Although still uncommon, the incidence of femoral head fractures has increased in recent times.[2] This trend is thought to be the result of two main factors: an increase in motor vehicle accidents and advances in modern vehicle safety, which have increased survival and allowed for more frequent identification of these fractures.[2]
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