Femoral head fracture

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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 fractures

Proximal

Shaft

Evaluation

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
  • 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

  • Immediate ortho consult
  • Emergent closed reduction of dislocation

Disposition

  • Admit

See Also

External Links

References