Diagnosis

Femoral head fracture, split 

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1. Diagnosis 
2. Vascularization through ligamentum teres 

1. Diagnosis 

Femoral head fracture, split

Femoral head fracture, split

These are split fractures of the femoral head that involve the articular surface. They disturb both the blood supply and the congruity of the articular surface. They are very often associated with a hip joint dislocation. The combination with an acetabular (posterior wall) fracture is also frequently seen.

In general, fractures of the femoral head are associated with dislocation of the hip. In 90% of cases, the dislocations are posterior and in 10% anterior.

An unreduced dislocation is an emergency because it threatens the blood supply to the femoral head. It may also be accompanied by pressure on a major nerve. Therefore, emergency reduction must be performed. If closed reduction succeeds, one has the luxury of time to investigate the patient further with a CT and then evolve an appropriate treatment rationale. If closed reduction fails, emergency open reduction must be undertaken.

Small fragments, which do not involve the weight-bearing portion of the femoral head, may be considered for primary resection, particularly if they block an anatomical reduction of the hip.

For an accurate diagnosis one needs AP and lateral views of the hip, and Judet views of the pelvis. The most accurate information comes from a CT. The diagnosis is often missed in case of small fractures, but even larger fractures are not always apparent on a standard pelvic x-ray.

Femoral head fracture, split

Femoral head fracture, split

2. Vascularization through ligamentum teres 

Vascularization through ligamentum teres

Vascularization through ligamentum teres

The ligamentum teres arises from the transverse acetabular ligament and the posterior inferior portion of the acetabular fossa and attaches to the femoral head at the fovea capitis. Lesions of the ligamentum teres may be caused by dislocation or subluxation of the hip as well as acetabular fractures. However, rupture may occur simply from a twisting injury in the absence of major trauma.