Functional outcome of patients with femoral head fractures associated withhip dislocations

Fracture of the femoral head after hip dislocation is a relatively rare inj ury often associated with a poor functional outcome. Twenty-six patients wh o sustained femoral head fractures were evaluated using radiographs, clinic al examinations, and a validated outcome scoring system. The Short Form-12 was used to assess functional outcome. Patients whose fractures were stabil ized with 3-mm cannulated screws and washers had a poor functional outcome. When evaluated with an odds ratio analysis, the use of Kocher-Langenbeck p osterior approach was associated with a 3.2 times higher incidence of the p atients having avascular necrosis develop when compared with the Smith-Pete rsen approach. A literature review combined with the current series confirm s that the principles of early reduction of hip dislocation, early stabiliz ation, anatomic reduction of the fracture, and rigid fixation are critical principles to attain good results. The Brumback classification system provi des superior differentiation of different fracture types when compared with the Pipkin classification. The Smith-Petersen anterior surgical approach i s recommended for the majority of patients with femoral head fractures. Thr ee-millimeter cannulated screws with threaded washers are contraindicated f or use in stabilizing femoral head fractures, and should not be used in any joint because of dissociation between the screw and the washer.