Features of the femoral head fractures treatment
In recent decades, the number of femoral head fractures (FHF) has been slowly increasing, which are due to an increase in the incidence of road traffic accidents and survival after high-energy injuries.
Objective: to analyze the results of surgical and conservative treatment of the FHF and to prove treatment tactics of this injury.
Methods: a retrospective analysis of the results of treatment of patients with the FHF from 2002 to 2017 was carried out. Before the operation X-ray and CT examinations of pelvic bones were made. Fractures were distributed according to the classification Pipkin: type I — 10 (25,6 %) patients, II — 7 (17.9 %), III — 1 (2.6 %), IV — 21 (53.8 %). Conservative treatment after elimination of dislocation was performed in 8 (20.5 %) patients: type Pipkin I — 6 (15.4 %); Pipkin II — 2 (5.1 %). Results: there were such complications as: heterotopic ossification in 1 (3.0 %) patients, aseptic necrosis of the femoral head — 7 (23.3 %), (2 — with fractures Pipkin II, 5 — Pipkin IV). In the period from 12 to 36 months after the injury, 32 (76.9 %) patients had got results of treatment according to the Thompson-Epstein scale: excellent — 9 (28.1 %), good — 10 (31.3 %), satisfactory — 5 (15.6 %), unsatisfactory — 8 (25.0 %).
Conclusions: in the case of type-fractures of Pipkin I and II, better functional results were obtained compared with the more severe type of Pipkin IV fracture. Late open reduction of displaced fractures resulted in the development of aseptic femoral head necrosis in 66.7 % of cases. The choice of the method of treatment of the FHF depends on the type of fracture. In the case of fractures like Pipkin I conservative treatment has led to a high percentage of good results. Under conditions of Pipkin II type fractures, the best indexes were observed after open reduction and osteosynthesis of fragments, Pipkin III — hip joint replacement, Pipkin IV — osteosynthesis of acetabulum and FHF.
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