Femoral Head Fractures

Femoral head-fracture dislocation, commonly known as Pipkin’s fracture dislocation, is an uncommon injury, but carries a grave prognosis because of its association with high velocity injury, posterior hip dislocation, and surgical complexities. Radiographs of the hip must be obtained in suspicious cases as often these fracture-dislocations are missed because of associated other system injuries. Computed tomographic scan with 3D reconstruction reveals the fracture pattern and is most helpful in treatment planning. Urgent hip reduction and careful planning for definite fixation of the femoral head fracture, aiming at preservation of capsular blood supply during surgical approach and congruent stable hip joint, are the goals of treatment. The trochanteric flip osteotomy approach provides a balanced solution in terms of associated complications and ease of exposure. Most infra-foveal fracture can be dealt conservatively while majority of supra-foveal fracture and associate acetabulum fracture warrants surgical fixation. Femoral neck and head fracture with hip dislocations have the worst prognosis after open reduction and internal fixation, and currently, the treatment for such fracture is shifting towards primary total hip replacement. Despite best possible management, a significant proportion of femoral head fracture-dislocation patients end up with osteonecrosis, heterotopic ossification, chondrolysis, hip instability, and secondary post-traumatic osteoarthritis.