SUMMARY
Femoral head fractures are rare, high-energy injuries most commonly associated with hip dislocations. These injuries are intra-articular and carry a high risk of avascular necrosis (AVN), post-traumatic arthritis, and long-term functional impairment. Early reduction and restoration of joint congruity are critical determinants of outcome.
EPIDEMIOLOGY
Rare compared to other hip fractures
Typically occur in young patients
Strong association with:
Posterior hip dislocation
High-energy trauma (MVC, dashboard injury)
ETIOLOGY & MECHANISM
Axial load transmitted through femoral shaft to femoral head
Posterior dislocation → shear force on femoral head
Associated injuries:
Acetabular fractures
Femoral neck fractures (Pipkin III → worst prognosis)
PATHOANATOMY
Articular cartilage disruption
Intra-articular loose fragments
Femoral head vascular compromise
Labral and capsular injury common
ANATOMY (SURGICALLY RELEVANT)
Blood supply:
Medial femoral circumflex artery (MFCA) dominant
Ligamentum teres contribution minimal in adults
Weight-bearing dome critical for outcomes
CLASSIFICATION (PIPKIN)
Type I: Inferior to fovea (non-weight bearing)
Type II: Superior (weight-bearing surface)
Type III: + femoral neck fracture
Type IV: + acetabular fracture
PRESENTATION
Severe hip pain
Deformity (dislocation)
Limited ROM
Sciatic nerve injury (up to 10%)
IMAGING
Radiographs:
AP pelvis
CT scan:
Mandatory
Fragment size
Articular congruity
Associated injuries
TREATMENT
Emergency Management
Urgent reduction (<6 hours)
→ AVN risk significantly decreases
Definitive Treatment
Type | Treatment |
Type I | Fragment excision |
Type II | ORIF |
Type III | Arthroplasty (often) |
Type IV | Combined fixation |
COMPLICATIONS
AVN
Post-traumatic arthritis
Heterotopic ossification
Sciatic nerve injury
PROGNOSIS
Depends on:
Reduction timing
Articular congruity
Associated injuries