A more comprehensive classification that includes anterior and central hip dislocations has been proposed by Brumback and colleagues. The Pipkin scheme does not differentiate the type of hip dislocation injury. A type IV fracture is a type I or II fracture with an associated acetabular fracture ( Fig. A type III fracture is a type I or II injury associated with a fracture of the femoral neck. A type I fracture involves the femoral head inferior to the fovea capitis, and type II fractures involve the femoral head superior to the fovea capitis. Associated complications include injuries to the sciatic nerve, AVN of the femoral head, periarticular heterotopic ossification, and secondary osteoarthritis.Īlthough several classifications exist, the Pipkin classification, which is based on the location of the femoral head fracture and the presence of associated acetabular or femoral neck fractures, is most widely used. Reportedly, femoral head fractures occur in 7% to 15% of posterior hip dislocation injuries and as high as 68% of anterior hip dislocations. The fracture occurs either from impaction or shearing. In a dashboard injury the hip is vulnerable to dislocation due to its flexed and adducted position. They are typically seen in the setting of high-velocity trauma that results in a hip dislocation, such as a motor vehicle accident. Intracapsular fractures are more susceptible to complications of nonunion, malunion, or avascular necrosis (AVN) of the femoral head due to the tenuous nature of the blood supply.įractures of the femoral head are relatively uncommon but often are associated with a poor functional outcome. Fractures of the proximal femur can be broadly categorized as intracapsular-those involving the femoral head or neck-or extracapsular-those involving the greater or lesser trochanters, the intertrochanteric or subtrochanteric regions. The greater and lesser trochanters serve as attachment sites for the gluteus medius and minimus muscles and iliopsoas, respectively.Īcetabular fractures are discussed in Chapter 16. The main vascular supply to the femoral head arises from an extracapsular vascular ring around the base of the femoral neck. The foveal artery courses through the ligamentum teres, providing a small contribution to the vascular supply of the femoral head. The ligamentum teres attaches to the femoral head at the fovea and attaches to the transverse ligament and margins of the acetabular notch. It is largely covered by cartilage except for a central depression termed the fovea capitis. The femoral head is a partial sphere articulating with the acetabulum. The synovial-lined capsule surrounds the hip joint with focal condensations forming the iliofemoral, pubofemoral, and ischiofemoral ligaments providing further stability to the joint. The acetabular labrum is a fibrocartilaginous structure that is firmly adhered to the acetabular rim and transverse ligament that serves to effectively deepen the socket, increasing the coverage of the femoral head and adding stability. The acetabulum is formed at the union of the ilium, ischium, and pubic bones and is partially covered by a horseshoe-shaped lining of hyaline cartilage. The relationships between the acetabulum, femoral head, labrum, and joint capsule make the hip an extremely stable joint. The hip is a large spheroidal (ball and socket) synovial joint. The cost of treatment of hip fractures is estimated at $10 billion to $15 billion per year in this country alone. Agency for Healthcare Research and Quality. In 2003 over 300,000 patients were hospitalized with hip fractures in the United States, accounting for 30% of all hospitalized patients according to data from the U.S. Worldwide the total number of hip fractures is expected to exceed 6 million by the year 2050. The hip is a common site of trauma and when injured can have a significant impact on the patient’s well-being.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |