Fractures of the femoral head are intraarticular. They may be associated with hip dislocations, acetabular fractures, or femoral neck fractures.
In split fractures (Pipkin) there is a fragment which has split off from the femoral head.
The optimal treatment strategy is not clear. Only anatomical reduction of the fracture fragments gives good long-term results. The treatment should therefore be focused on restoration of the articular surface, combined with treatment of any associated injuries.
Osteochondral fragments cranial to the ligamentum teres are usually part of the weight-bearing surface, making anatomical reduction mandatory.
|ORIF - Small fragment screws|
|Split fractures with more proximal “Pipkin II” or larger fragments|
- Split fracture in a patient fit for surgery
- Unsuccessful closed reduction
- Accompanying significant acetabular fracture
- Residual instability
- Interposed fragments in the hip joint
- Sciatic nerve deficit, not present prior to reduction
- Contaminated or infected local wound
- Patient not fit for surgery
- Anatomical reduction (congruent joint)
- Stable fixation
- Risks of surgery
- Risk of heterotopic ossification
- Choice of implant
Resorbable screws do not need removing, but may be relatively weak.
If metal screws are used, titanium is a better choice than steel, as it does not interfere with subsequent MRI imaging.
Intraosseus self-compressing screws cause less damage to the articular cartilage than conventional screws, and there is less risk of a prominent screw head causing secondary articular surface damage.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|