Late results after fracture of the femoral head

The dislocation fracture of the femoral head is the result of high speed tr auma. Most of the patients have additional injuries. The prognosis of this kind of fracture of the femoral head depends on the type of fracture, the a dditional injuries and the age of the patients. The diagnosis and the speci fic treatment are most important, since most of the patients with this inju ry are of a younger age. The reposition of the fracture has to be performed within 6 hours. In our opinion, this should be done by surgery if possible . For the operation some routine pelvic X-rays and a CT of the pelvis shoul d be prepared. The therapy depends on the type of fracture. In patients wit h Type I and II fractures the broken head fragments should be refixed by on ly taking out small parts of bone which are not elementary for the pressure zone of the femoral head. Younger patients with Type III fractures should always receive the possibility of a screw fixation of the neck of femur, wh ereas total hip replacement should generally be achieved in the older patie nt. An exact reconstruction of the dorsal acetabulum must be performed in P ipkin Type IV fractures. The usual approach for Type I-III fractures is the ventrolateral Smith-Peterson and lateral Watson-Jones, for Type IV fractur es, the dorsal Kocher-Langenbeck approach. We suggest indometacine as a pro phylaxis for ossifications due to high tissue damage. Several scores for th e evaluation and documentation of the outcome of this kind of fracture are useful: the clinical results according to Merle d'Aubigne, social status sc ored by the Karnofsky Index and X-ray results using Brooker and Helfet to c lassify the heterotopic ossification and post traumatic joint changes.