[Fractures of the femoral head]

The authors summarize their experience in the diagnosis and therapy of femoral head fractures with the aim to make an analysis of the femoral head fractures, a retrospective evaluation of the group of patients and determine diagnostic and therapeutic criteria.

The group of patients comprises 60 patients with the injury of 61 hips in the period of 10 years. The follow-up comprised all hips with any injury of the head. On this basis an extensive group of patients was developed including 31 fractures of Type I-III after Pipkin and 30 fractures of Type IV. The average age of patients was 40.7 years. The evaluation covered 51 fractures with the minimal follow-up period of 24 months, fully valid data were obtained in 38 patients.

The group of patients was evaluated according to the type of surgery, type of internal fixation. Early and late complications were assessed, particularly the development of aseptic necrosis and osteoarthritis.

The results were evaluated by individual types of injury and in summary. Of 38 evaluated hips 8 were primary THR, in the remaining 30 hips there were 3 without sequelae, in 11 cases avascular necrosis and in 16 cases osteoarthritis developed. Subsequently THR was performed in 11 patients. Thus, in total the operation including primary THR was performed exactly in 50% of joints.

In harmony with other literary sources the authors consider this injury of the hip as a very serious one leading to a severe damage to the structure of the joint and its vascularization. Indication for operation is urgent unless closed anatomical reduction of the fragment is achieved. With regard to a high number of Type IV fractures the authors discuss in detail the type of the injury of the head in case of the fracture of acetabulum and compare various classifications of this injury and postulate a subclassification of Pipkin Type IV.

The authors subdivide Pipkin Type IV into A subtype (chondral fracture of the head), B subtype (osteochondral fracture of the head, subtype C (compression of the head) and subtype D (fragment of the head exceeding 1 cm).