Femoral head fracture: Difference between revisions
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==Background== | ==Background== | ||
===Anatomy=== | |||
*Blood supply | |||
**Femoral head has 3 sources of arterial supply | |||
***extracapsular arterial ring | |||
****medial circumflex femoral artery (main supply to the head) | |||
*****from profunda femoris | |||
****lateral circumflex femoral artery | |||
***ascending cervical branches | |||
***artery to the ligamentum teres | |||
****from the obturator artery or MCFA | |||
****supplies perifoveal area | |||
{{Femur fracture types}} | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Heupfractuur.jpg|thumb|Hip fracture with shortened and externally rotated leg.]] | |||
*Results from high-energy trauma (e.g. dashboard to flexed knee) | *Results from high-energy trauma (e.g. dashboard to flexed knee) | ||
*Can occur with dislocation: | *Can occur with [[hip dislocation|dislocation]]: | ||
**Posterior dislocation | **Posterior dislocation | ||
***Affected leg appears shortened, internally rotated, adducted | ***Affected leg appears shortened, internally rotated, adducted | ||
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***Affected leg appears shortened, externally rotated, abducted | ***Affected leg appears shortened, externally rotated, abducted | ||
***Fracture of anterior femoral head; concomitant vascular injury | ***Fracture of anterior femoral head; concomitant vascular injury | ||
*Associated Conditions: | |||
**[[Femoral neck fracture]] | |||
**acetabular fracture | |||
**sciatic nerve neuropraxia | |||
**ipsilateral knee ligamentous instability | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Hip pain DDX}} | ||
==Evaluation== | ==Evaluation== | ||
{{Proximal femur fracture diagnosis}} | {{Proximal femur fracture diagnosis}} | ||
*Classified using the Pipkin System | |||
**Type 1 - Frx below fovea/ligamentum (small) | |||
**Type 2 - Frx above fovia/ligamentum | |||
**Type 3 - Type 1 or 2 associated with femoral neck frx | |||
**Type 4 - Type 1 or 2 associated with acetabular frx | |||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*Immediate ortho consult | *Immediate ortho consult | ||
==Disposition== | ==Disposition== | ||
Latest revision as of 23:33, 17 March 2021
Background
Anatomy
- Blood supply
- Femoral head has 3 sources of arterial supply
- extracapsular arterial ring
- medial circumflex femoral artery (main supply to the head)
- from profunda femoris
- lateral circumflex femoral artery
- medial circumflex femoral artery (main supply to the head)
- ascending cervical branches
- artery to the ligamentum teres
- from the obturator artery or MCFA
- supplies perifoveal area
- extracapsular arterial ring
- Femoral head has 3 sources of arterial supply
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
Clinical Features
- Results from high-energy trauma (e.g. dashboard to flexed knee)
- Can occur with dislocation:
- Posterior dislocation
- Affected leg appears shortened, internally rotated, adducted
- Fracture of inf aspect of femoral head; concomitant sciatic nerve injury
- Anterior dislocation
- Affected leg appears shortened, externally rotated, abducted
- Fracture of anterior femoral head; concomitant vascular injury
- Posterior dislocation
- Associated Conditions:
- Femoral neck fracture
- acetabular fracture
- sciatic nerve neuropraxia
- ipsilateral knee ligamentous instability
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Evaluation
- Consider AP pelvis in addition to AP/lateral views to compare contralateral side
- Consider MRI if strong clinical suspicion but negative x-ray
- Classified using the Pipkin System
- Type 1 - Frx below fovea/ligamentum (small)
- Type 2 - Frx above fovia/ligamentum
- Type 3 - Type 1 or 2 associated with femoral neck frx
- Type 4 - Type 1 or 2 associated with acetabular frx
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Immediate ortho consult
Disposition
- Admit