FRACTURES OF THE FEMORAL-HEAD - LONG-TERM RESULTS OF CONSERVATIVE ANDOPERATIVE TREATMENT

From 1974 to 1989, we treated 32 patients with a femoral head fracture : 28 were associated with a traumatic posterosuperior dislocation of t he hip (6 Pipkin type I, 7 type II, 4 type III and 11 type IV), 1 with a posteroinferior and 3 with an anterior displacement of the femoral head. Twenty-four patients had been involved in a traffic accident, 23 had associated injuries, and the average polytrauma score (PTS) was 2 1. All dislocations primarily treated at our hospital were reduced by closed methods within 4 h (mean 105 min). Eleven patients received no further operative treatment, 21 were treated by open reduction and scr ew fixation of the fragment of the head (n=7), fixation of the acetabu lar fracture (n=3) or removal of the fragments of the head (n=10). Fou r Pipkin type III fractures received primary total hip replacement. Tw enty-six of the surviving 29 patients were reviewed after an average f ollow-up of 5 years (2-11). Radiological signs of mild arthrosis were seen in 4, moderate degeneration in 2. Partial avascular necrosis was found in 4, subchondral collapse in 1 and heterotopic ossification in 8 patients. According to the Thompson and Epstein criteria 15 of 26 pa tients presented fair to poor results.