STUDY OF THE TREATMENT OF FEMORAL HEAD FRACTURES

Rodrigo Pereira Guimaraes; Gilliatt Saeki de Souza; Sandro da Silva Reginaldo; Nelson Keiske Ono; Emerson Kiyoshi Honda; Giancarlo Cavalli Polesello; Walter Riccioli Jr

doi:10.1016/S2255-4971(15)30381-5

STUDY OF THE TREATMENT OF FEMORAL HEAD FRACTURES

Rev Bras Ortop. 2015 Nov 17;45(4):355-61. doi: 10.1016/S2255-4971(15)30381-5. eCollection 2010 Jul-Aug.

Authors

Rodrigo Pereira Guimaraes¹, Gilliatt Saeki de Souza², Sandro da Silva Reginaldo³, Nelson Keiske Ono⁴, Emerson Kiyoshi Honda⁵, Giancarlo Cavalli Polesello⁶, Walter Riccioli Jr⁶

Affiliations

¹ MSc from FCMSCSP and Lecturer; Attending physician in the Hip Group, Department of Orthopedics and Traumatology, FCMSCSP.
² Orthopedist and former trainee in the Hip Group, Department of Orthopedics and Traumatology, FCMSCSP.
³ PhD from FCMSCSP and Assistant Professor; Head of the Hip Group, Department of Orthopedics and Traumatology, FCMSCSP.
⁴ PhD from FCMSCSP and Lecturer; Senior Member of the Hip Group, Department of Orthopedics and Traumatology, FCMSCSP.
⁵ PhD from FCMSCSP and Assistant Professor; Attending Physician in the Hip Group, Department of Orthopedics and Traumatology, FCMSCSP.
⁶ Orthopedist and Attending Physician in the Hip Group, Department of Orthopedics and Traumatology, FCMSCSP.

Abstract

Objective: To establish guidelines for the treatment of femoral head fractures and to determine the best form of access in cases treated surgically.

Methods: We evaluated the clinical and radiological results from 13 patients (13 fractures) treated surgically, between May 1986 and July 1996, at the Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de Sao Paulo (SCMSP), Fernandinho Simonsen Wing.

Results: Out of six cases of Pipkin 1 fractures, five underwent resection of the fragment, resulting in four excellent and one good result. The good result had fixation of the fragment. Three patients presented Pipkin 2 fractures and all of them had fixation of the fragment, resulting in two excellent and one regular result. Two patients had Pipkin 3 fractures and underwent primary arthroplasty. Among the two patients with Pipkin 4 lesions, one was treated with reduction and osteosynthesis of the acetabular fracture, without addressing the head fragment, which had reduced significantly, resulting in early arthrosis; and the other patient was treated with total arthroplasty as the primary treatment.

Conclusion: Upon comparing the literature review and our patients' treatment results, we concluded that femoral head fracture treatment needs to be surgical and that the choice of surgical access depends on the type of fracture.

Keywords: Femoral head; Femur; Fracture consolidation; Fracture fixation.