FRACTURES OF THE FEMORAL HEAD (CLINICAL LECTURE)

Abstract

Fractures of the femoral head are often associated with hip dislocation. A high percentage of unsatisfactory functional treatment outcomes and complications (such as aseptic necrosis, heterotopic ossification, osteoarthritis, etc.) remains a challenge. Objective. To analyze the available information on the treatment approaches for femoral head fractures associated with hip dislocation using the Pipkin classification. Methods. A search of modern literature sources was conducted in the PubMed and Scopus databases using the following keywords: fracture, femoral head, Pipkin, hip joint, diagnosis, treatment, osteosynthesis. Results. The Pipkin classification enables the systematization of treatment approaches for patients and, when applied correctly, reduces the rate of complications and improves functional outcomes. Computed tomography is an essential procedure in diagnosing femoral head fractures associated with hip dislocation to facilitate the prompt reduction of the dislocation. The specific features of blood supply and the risks of aseptic necrosis formation, considered in the Pipkin classification, influence the treatment strategy, along with the type of fracture. For type I fractures, both conservative and surgical methods are possible. For type II fractures, screw fixation is preferred: using hidden compression screws, self-compressing headless screws, or bioresorbable screws. For type III fractures, urgent surgery is required, typically open reduction with primary endoprosthesis replacement. For type IV fractures, if the fracture type permits, open reduction and osteosynthesis are recommended. In postoperative care, early functional treatment is critical, with partial weight-bearing for 6–12 weeks, and avoiding excessive flexion of the hip beyond 45°–50°. Conclusions. A properly selected treatment strategy during the initial admission can reduce recovery times and improve treatment outcomes.