Elizabeth Hofheinz, M.P.H., M.Ed.
A “first” in the literature, a new evaluation of 10-year functional outcomes in patients with femoral head fractures includes 28 patients and a minimum of 10 years of clinical follow-up. The retrospective review, which took place at a single academic level-1 trauma center, was titled, “Patient-Reported Outcomes of Femoral Head Fractures with a Minimum 10-Year Follow-Up.” The study appears in the December 2020 edition of the Journal of Orthopaedic Trauma.
What the X-Ray didn’t catch
Co-author David Templeman, M.D. told OSN, “The study was conducted because in reviewing the literature there were very few series that reported results with follow up extending beyond 5 years and very little data with patient reported outcomes. We have, in the care of our patients noted significant chondral injuries to the femoral head that are not evident with x-rays or advanced imaging; we were interested in studying the long-term function of these injuries.”
The researchers took note of the approach (anterior and posterior), timing of fixation, and implant details. Treatment was “nonoperative,” “ORIF of the femoral head,” “fragment excision,” or “arthroplasty.” If a case involved a concomitant acetabular fracture that underwent surgical fixation, the researchers noted the treatment as “ORIF of the femoral head,” “ORIF of the acetabulum,” or both.
The authors wrote, “…The average follow-up was 14 (10–25) years. Overall, the average age at injury was 39.2%, and 72% of patients were men. The mechanism of injury was predominately motor vehicle related (86%). All injuries were high energy in nature. Associated bony injury occurred in 82% of patients with half of those injuries including an acetabular fracture…Associated hip dislocation occurred in 23 patients, 22 patients with posterior dislocation and 1 with anterior dislocation. Surgical management occurred in 86% of patients, and the mean time to definitive treatment was 3.7 (0–25) days…”
A total of 21 patients had a complication. Seven had conversions to total hip arthroplasty (THA) at roughly 6.4 years from the initial injury; three of the seven late THA conversions necessitated later revision.
Dr. Templeman commented to OSN: “I was surprised at the good functional outcome in some of the patients that had excision of their femoral head fracture fragments.”
“I think this calls for better data; both in terms of bigger numbers of patients and patient reported outcomes. It would hopefully lead to a registry.”
Dr. Templeman and his colleagues advise that “patients should be counseled that the long-term results of open reduction and internal fixation may be satisfactory but unfortunately are not predictable.”