Is the Surgical Approach Affecting the Late Outcome Results of Open Reduction and Internal Fixation of Femoral Head Fractures?

Femoral head fracture is a relatively rare injury which often associates with a poor functional outcome. The surgical approaches for femoral head fracture are a controversial subject in many study reports. Patients and Methods Nineteen patients suffering from femoral head fracture-dislocation of the hip were admitted to Zagazig university hospital. The fractures were classified according to the Pipkin classification and all of them were classified as Pipkin Type-II. All fractures were associated with a posterior dislocation Thompson &Epstein type V. The anterior approach (Smith–Petersen) was used in eight cases, the lateral transgluteal or Thomine modification of Hardinge approach was used in six cases and the posterior (Kocher–Langenbeck) was used in five cases. The results, evaluations were based on clinical and radiographic evaluation, with Thompson &Epstein score and clinical evaluation, with the Merle d’Aubigné &Postel score. Results After Followup ranging from 2 to 5 years for all patients (range24-60months, main was 34 months), the overall outcome was excellent at 40%, good at 10%, fair at 32%, and poor in 18%. Avascular necrosis was seen in four cases, three of them were with the posterior approach (one case from the three cases done through a posterior approach suffered from hip sublaxation combined with avascular necrosis), and one case was with the anterior approach. Heterotrophic ossification (Brooker, type I) was seen in one case with the anterior approach. Conclusion The lateral transgluteal or Thomine modification of the Hardinge approach giving promising long-term functional results and lower incidence of major complication rates.