FEMORAL HEAD FRACTURES

Healing a Deep Fracture

Fracture of the femoral head is a rare injury and is almost always associated with a posterior dislocation of the hip. It is caused by high energy trauma and can have potentially devastating complications like post-traumatic Arthritis, Avascular Necrosis (AVN) of the head or hip instability.

THE CASE

A 46 year old male was brought to the casualty of Nanavati Super Speciality Hospital, Mumbai following Renal Tubular Acidosis (RTA). He complained of pain and deformity of his right hip with an inability to bear weight. A detailed examination revealed the classical deformity of flexion, adduction and internal rotation of the right hip with shortening, suggestive of a posterior hip dislocation. X-rays and CT scan confirmed the clinical diagnosis of a hip dislocation and an associated fracture of the femoral head.

THE PROCEDURE

The hip was reduced on an emergent basis on the day of injury and the patient was put on skin traction. The patient was taken up the next day for fixation of the fracture. This was done after placing the patient in the lateral position and administrating spinal anaesthesia. The safe surgical dislocation approach as described by Ganz was used. A Trochanteric Flip Osteotomy was done and the anteriorly dislocated hip exposed the fracture. The fracture was fixed under vision using Headless Cannulated Screws (HCS). The Trochanteric Osteotomy was fixed with 4mm cannulated cancellous screws.

THE RESULT

Post-operation, hip motion exercises were started on the first day. From the second day, he was mobilised with a non-weight bearing walker and discharged on the fifth day. He regained full movement of the hip by the fourth week. At six weeks, partial weight bearing was permitted, gradually progressing to full weight bearing by three months. The fracture healed in four months without any complications.

Dr. Sunil Shahane

Dr. Sunil Shahane
Sr. Consultant
Orthopaedics & Joint
Replacement
Nanavati Super Speciality
Hospital, Mumbai



Ganz approach is an excellent approach for treating difficult fractures. Its many advantages are:
  • Preserves vascularity of the femoral head thus reducing risk of AVN
  • Complete exposure of the femoral head allowing fixation of the fracture under vision
  • Allows complete removal of all debris from the joint reducing risk of Arthritis


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