Femoral head fracture: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*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 | ||
Revision as of 17:50, 28 September 2019
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
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
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
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