Femoral head fracture

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

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
• Associated Conditions:
  • Femoral neck fracture
  • acetabular fracture
  • sciatic nerve neuropraxia
  • ipsilateral knee ligamentous instability

Differential Diagnosis

Femur Fracture Types

Proximal

• Intracapsular
  • Femoral head fracture
  • Femoral neck fracture
• Extracapsular
  • Intertrochanteric femur fracture
  • Trochanteric femur fracture

Shaft

• Mid-shaft femur fracture (all subtrochanteric)

Evaluation

Hip fracture classification.

Location of femur fractures

• Consider AP pelvis in addition to AP/lateral views to compare contralateral side
• Consider MRI if strong clinical suspicion but negative x-ray

Management

• Immediate ortho consult
• Emergent closed reduction of dislocation

Disposition

• Admit

See Also

• Femur fracture