The Related Influential Factors Of Treatment And Prognosis For The Femoral Head Fracture In Young Adults

Background: The femoral head fracture is high-energy injury, infrequently accompany fracture or fracture-dislocation of the hip. In recent years, the risk of the fracture is higher and higher with the development of communication and industry. The optimal treatment of femoral head fractures remains poorly defined and had been associated with a relatively poor functional outcome either from the injury itself or from its surgical treatment. The femoral head has its special and complex anatomy structure, some complications like: avascular necrosis(AVN), heterotopic ossification, fixation failure, and post traumatic arthritis might occur. Fractures of the femoral head by ifself represented a complex therapeutic dilemmas for orthopedic surgeon, as no clear guidelines regarding the classification system, line of treatment, surgical approach, surgical technique and implant material used for fixation, especially for the young adults. The review for the treatment and prognosis of femoral head fracture will improve the comprehension and make good sense to the choice in these often severe injuries.ObjectⅣe: To discuss treatment and prognosis with absorbable screws for the different type fracture of the femoral head in young adults, in order to make reference for the choice of surgical approach and enhance the clinical results.Method: Review the 41 cases of the fracture of the femoral head that are cured in our hospital in 2000—2010. Of the 41 cases, 24 are male and 17 are female. The age is 17~49 years old, and the average is 29.3 years old. The mechanism of injury was RTA in 32 patients and fall accident in 9 patients. The right hip was injured in 18 patients and the left hip in 23 patients. The hip dislocation is 21 cases, the sciatic nerve injury is 2 cases. According to Pipkin's fracture classification: type I fracture was found in 10 patients, typeⅡin 13 patients, typeⅢin 3 patients and typeⅣin 15 patients. Various procedures were taken according to classification, age, pathology and general conditions. S-P approach was used in 17 patients and K-L approach was used in 20 patients. Eight femoral head fracture Pipkin type I were treated with excision of the fragment as it was difficult to fix and it did not affect the stability of the hip, while the other two patients was treated with absorbable screws. Eleven femoral head fractures with Pipkin typeⅡwere treated with absorbable screws. Three femoral head fracture with Pipkin typeⅢwere treated with absorbable screws while femoral neck fracture were fixed with metallic screws. Open reduction and internal fixation of associated acetabular fractures were done for 15 patients with femoral head fracture.Result: Follow-up study is 12 months~60 months, and the average is 32 months. There were three presurgical nerve lisions that were sequelae of the injury. Complications included avascular necrosis (AVN) in two cases, post traumatic arthritis in two cases, no heterotopic ossification, deep infection or recurrent dislocation. According to the criteria of Thompson-Epstein, 7 patients were excellent, 23 patients were good, 8 patients were fair, 3 patients were poor, the excellent and good rate was 73.1%. Analysis by chi-square test results:○1Significant differences were found between Pipkin fracture classification and clinical effect(P<0.05).②No significant differences were found between operative time and effect(P≥0.05).③Significant differences were found between surgeon approach and effect(P<0.05).④No significant differences were found between surgical technique and effect(P≥0.05).⑤No significant differences were found between post-operative weight-bearing and effect(P≥0.05).Conclusion: The classification of femoral head fracuter has a significant relationship with the clinical effect. Pipkin I,Ⅱ,Ⅳcan obtain better treatment results, while typeⅢoften receive poor treatment outcome.②The operation time after fracture had no significant effect. For the number of patients operative emergencive is poor, definitive conclusion needs further observation.③Different surgeon approach has a significant relationship with clinical effect. S-P approach and K-L approach can obtain better results than complex approach.④No significant differences were found between surgical technique and effect.⑤The differences between post-operative weight-bearing and clinical effect is not significant.