Clinical and radiographic outcome of femoral head fractures - 30 patients followed for 3-10 years

The aim of this study was to evaluate the outcome of 30 femoral head fractu res. We modified Pipkin's classification into 4 types: I (5 cases) small fr acture of head distal to fovea centralis, which was too small or too fragme nted to be fixed with screws; II (18 cases), larger fracture of head distal to fovea centralis; III (4 cases), large fracture of head proximal to fove a centralis, and IV (3 cases), comminuted fracture of head. Excision of the head fragment was done in all 5 cases of type I and in 9 ty pe II fractures. Fixation of the head. fragment was performed in 9 type Il and in all 4 type III cases. The femoral head was replaced in all 3 type IV fractures. After a mean follow-up of 3-10 years, the clinical outcome, acc ording to Epstein et al.'s critieria, were excellent in 7, good in 15, fair in 4 and poor in 1, except in type IV, and the radiographic outcome was ex cellent in 15, good in 7, fair in 4 and poor in 1. On the basis of our findings, we conclude that excision of the small fragme nt is a good choice of treatment in type 1. Early accurate reduction with s table internal fixation in type II or III permits bony union. Arthroplasty seems to be indicated in type IV.