The surgical management of femoral head fractures occurring with anterior dislocation of the hip

Abstract

Anterior dislocation of the hip may have associated fractures of the femoral head which involve the weight-bearing surface. The impression fracture involves the superolateral portion of the head, and the osteochondral fracture involves the anterosuperior portion. CT scan, arthrograms, and tomograms may be used to further assess the status of the femoral head. If CT scan or other diagnostic studies show no osteochondral fracture, no significant impression fracture, and no fragments within the joint, the hip is treated nonsurgically. Small osteochondral fragments not large enough for internal fixation are excised. Larger osteochondral fragments are treated with open reduction and internal fixation. Impression fractures of the femoral head deeper than 2 mm on CT scan or open inspection are treated by elevation of the defect, bone grafting, and internal fixation. All treatment modalities include the use of continuous passive motion in the postoperative phase.