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
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 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.
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.