Fractures of the femoral head: a long-term follow-up study

The femoral head fracture has become an increasingly frequent injury, usually sustained by individuals during high-energy trauma. Regardless of the type of treatment, long-term consequences, as avascular necrosis, post-traumatic arthritis, and heterotopic ossification, may complicate the clinical outcome leading to variable degree of disability. The aim of this study was to review the clinical and radiological long-term follow-up of patients with a fracture of the femoral head. Between January 1985 and January 2002, twenty-one patients with mean age 42.0 ± 15.9 years (range, 21–70 years) with a fracture of the femoral head were evaluated retrospectively. According to Pipkin’s classification, there were four type I, nine type II, and eight type IV fractures. Functional outcomes were measured using the Merle d’Aubigné-Postel and Thompson–Epstein scoring scale. Heterotopic calcifications was graded according to the Brooker classification. All patients were followed up from 12 to 210 months, with an average of 81.19 ± 37.4 months. The average Merle d’Aubigné-Postel score was 12.9 ± 4.5. According to the Thompson–Epstein criteria, eight patients had excellent results, eight patients good, two patients fair, and three patients poor results. Overall, almost all (95. 2%) patients were determined to have radiographic criteria of post-traumatic arthritis (PA). Ten patients (47.6%) had a mild PA, seven patients (33.3%) had a moderate PA, and three patients (14.2%) had a severe PA. Open reduction and internal fixation of the fragments provided better results in comparison to excision. Although degenerative changes of the hip were observed in almost all patients, most severe case occurred in the excision group.