FEMORAL HEAD FRACTURE

FEMORAL HEAD FRACTURE

 

How do you define femoral head fracture? Where is the bone called femur located? Why and how does a femur fracture? Who are the people more susceptible to femoral head fracture? What are the necessary steps for treatment and prevention?

Femur is the longest and is one of the strongest bones of the body. Femur is placed in the proximal part of lower limb, and is supplied by various nerves and vessels. This the part of body well known to be used for graft purposes but itself susceptible to a number of complications and injuries, which follows a number of serious interventions and care.

What will be discussed in the article:

 

Femoral head fractures

  1. Type 1: Stress fracture

  2. Type 2: Severe impaction fractures

  3. Type 3: Partial fracture

  4. Type 4: Completed displaced fracture

  5. Femoral Head Fractures

  6. Femoral Condyle Fracture

 

Symptoms

Complications

 

Pediatric femoral head fracture

 

Femoral head fracture recovery

Femoral head fracture treatment

Takeaway

 

 

Femoral head fractures

Anatomy of femur:

The femur is the only bone in the thigh and the longest and one of the strongest bones in the body.

It acts as the site where the muscles arise from and attachment of many muscles and ligaments, and can also be divided into three parts; proximal, shaft and distal.

Proximal: The proximal side of the femur is articulated with the acetabulum of the pelvis to form the hip joint.

It consists of two parts as: head and neck, and two bony processes are also found- large and small, called as greater and lesser trochanters. There are also two bone ridges that connect the two trochanters. The intertrochanteric line is in the front and the intertrochanteric ridge is in the rear.

Head- Joints with the acetabulum of the pelvis to form the hip joint. It has a smooth surface covered with articular cartilage (except for the small depressions-fovea-to which ligament teres adheres).

Neck- Connects the femoral head to the shaft. It is cylindrical and protrudes up and inward. It is set at an angle of about 135 degrees with respect to the shaft. This projection angle increases the range of motion of the hip joint.

Greater trochanter- The most laterally palpable bone process that starts from the front and connects directly to the side of the neck. This is the attachment point for many gluteus muscles, such as the gluteus medius, gluteus minimus, and piriformis. The vastus lateralis begins at this point. Strong contractions of the gluteus medius can lead to avulsion fractures of the greater trochanter.

Lesser trochanter- Smaller than the greater trochanter. It protrudes from the posteromedial side of the femur just below the junction of neck-shaft This is the attachment point of the iliopsoas muscle (its strong contraction can cause a fracture of the lesser trochanter).

Intertrochanteric line- A ridge of bone that runs inferior-medially in front of the femur and straddles between the two trochanters. After passing through the lesser trochanter on the posterior surface, it is called the pectineal line. This is the attachment point for the iliac femoral ligament (the strongest ligament in the hip joint). It also acts as an anterior approach to the hip capsule.

 

Shaft: The shaft of the femur is in slightly medial direction as it comes down, this brings the knee closer to the center of gravity and improves stability.

On the posterior surface of the femoral shaft, there is a rough bone ridge called- linea aspera.

Proximal, the inner border of the linea aspera is the pectineal line. The lateral edge becomes a rough surface where the gluteus maximus is attached and extends distally and forms the floor of the popliteal fossa. The medial and lateral boundaries are formed by the medial and lateral epicondyle lines.

Distal: The distal end of the femur articulates with the tibia and patella to form the knee joint and is characteristic feature if it.

Medial and lateral condyles- a rounded area at the end of the femur. The posterior and inferior surfaces are jointed to the tibia and meniscus of the knee, and the anterior surface is articulated to the patella. The more prominent lateral condyle helps to prevent the lateral movement of the patella that occurs naturally. Flatter condyles are more likely to cause patellar dislocation.

Medial and lateral epicondyles- Bone prominence in the non-articular area of ​​the condyle. The medial epicondyle is large.

The medial and lateral collateral ligaments of the knee come from their respective epicondyles.

Intercondylar fossa-A deep notch on the posterior surface of the femur between the two condyles. Includes two facets to secure the intracapsular knee ligament. The anterior cruciate ligament (ACL) is attached to the medial side of the lateral condyle and the posterior cruciate ligament (PCL) is attached to the lateral side of the medial condyle.

Femoral neck fractures (NOFs) are becoming more common and tend to afflict older people due to low energy loss in the presence of osteoporotic bone. They are more common in females. In patients that are young, it is more likely to happen due to result of a high energy accident.

The distal fragment is usually pulled up and rotated laterally. It clinically appears as a shortened, externally rotated lower limb.

These fractures can be broadly divided into two groups:

Intra-capscular: this is the type where the fracture occurs within the hip capsule. It can damage the medial circumflex artery and cause avascular necrosis of the femoral head.

Extracapsular: Avascular necrosis is a rare complication because the blood supply to the femoral head is intact.

Fractures of the femoral shafts are usually high-energy injuries, but can occur in the elderly as a result of low-energy falls.

They often appear as spiral fractures, shortening the legs. The loss of leg length is due to the superposition of bone fragments pulled by the attached respective muscles. Due to the high energy levels of the injury method, the surrounding soft tissue can also be damaged. At-risk neurovascular structures include the femoral nerve and arteries. Closed fractures of the femoral shaft can cause serious bleeding (1000-1500 ml).

 

  • Common fractures of femur

 Four types of fractures can be defined as follows and is defined on the basis of severity of fracture:

Type 1: Stress fracture

Type 2: Severe impaction fractures

Type 3: Partial fracture

Type 4: Completed displaced fracture

 

Stress fractures are small cracks in the bone. Stress fractures as suggested by the name are often caused by overuse, for example, high-impact exercise. Most stress fractures occur in the bones that support your weight. Stress fractures are injuries caused by overuse. When the muscles are exhausted, they can no longer mitigate repeated thrust shocks. The muscles transfer the load to the bones. This can cause small cracks and breakage.

 

Severe Impaction Fractures: it is a type of fracture where the bone splits into many different pieces and are driven into each other. This is a closed fracture that occurs when pressure is applied to both ends of the bone and the bone splits into two pieces that form a wedge.

 

Partial fracture is an incomplete fracture of the bone. This type of fracture refers to the way a bone breaks. If the fracture is incomplete, the bone will break, but not completely. In contrast, there is a complete fracture in which the bone splits into two or more parts

 

Complete Displaced Fracture: If the bone breaks in more than one part and is not properly aligned. Fracture dislocation is defined as the abnormal position of the distal fracture with respect to the proximal bone.

 

By location/ on the basis of location:

Femoral fractures are located in three different locations as described below:

Femoral Head Fractures: Stress fractures of the femoral head are a common cause of hip pain in some selected population groups. Chronic repetitive activities that are more common to runners and recruits of military make these groups to be at a risk of femoral neck stress fractures.

 

 Head Fracture: Pipkin Classification

 A: Type I- subfoveal Femoral Head Fracture

 B: Type II- fracture extending above the fovea 

C: Type III- femoral head fracture with associated femoral neck fracture

 D: Type IV- femoral head fracture with acetabular fracture

Shaft fractures of the femur are defined as fractures of the shaft that occur 5 cm distal to the lesser trochanter and 5 cm proximal to the turbercle of adductor. Fractures of femoral shaft most often occur in young men after high-energy trauma and older women after low-energy falls. Kenny (2013) reported three types of fractures of femur shaft: It explains as follows:

Type I- spiral or transverse and is the most common

Type II - comminuted

Type III- open

 

Femoral Condyle Fracture: This can occur after ACL reconstruction of the medial hamstring tendon with extra-articular tendon fusion. Fractures occur between the fixation site of extra-articular augmentation and the intraosseous femoral tunnel.

 

  • Introduction to fractures

Fractures of the femoral head are serious and relatively rare injuries. This usually occurs after traumatic posterior dislocation of the hip joint.  Pipkin classification system is the most usual and commonly used classification system. Diagnosis is assisted by diagnostic imaging, including a complete medical history, physical examination, and computed tomography. Treatment consists of emergency reduction of hip dislocation followed by non-surgical or surgical management of the associated fracture. Complications associated with femoral head fractures and subsequent treatment include osteonecrosis, post-traumatic osteoarthritis, and ectopic ossification. Fractures of the femoral head are associated with relatively poor functional outcomes.

 

Risk factors for femoral head fractures:

Age: The rate of hip fractures increases significantly at higher age as the bone density and muscle mass decrease with age. Also, older people also have problems with their eyesight and balance, which can increase their risk of falls.

Gender: Hip fractures are about three times more likely to occur in females than in males. Bone density of females is lost faster than men. This is because the decrease in estrogen levels that accompanies menopause accelerates bone destruction. However, men can also develop dangerously low bone density.

Osteoporosis: This condition of weakening bones increases the risk of fractures.

Other chronic illnesses: Endocrine disorders such as hyperthyroidism can make bones brittle. Enteropathy, which can reduce the absorption of vitamin D and calcium, can also weaken bones.

Brain and nervous system disorders: There are disorders such as cognitive impairment, dementia, Parkinson's disease, stroke, and peripheral neuropathy, which in addition to their own symptoms, also increase the risk of falls.

Hypoglycemia and low blood pressure: These can also increase the risk of falls.

Some drugs: Cortisone drugs/ or corticosteroids like prednisone might result in weakened bones when taken for longer periods of time. Certain medications, or specific combinations of medications, can cause dizziness and make a person more prone to falls.

Drugs that act on the central nervous system, such as sleeping pills, antipsychotics, and sedatives, are most commonly associated with falls.

Nutritional problems: A dietary deficiency of calcium and vitamin D reduces maximum bone mass at a young age and increases the risk of fractures in later years. It's also important to get enough calcium and vitamin D as a person gets older to try to preserve the bone density left.

Some preventive measures can be followed as well like: Trying to maintain a healthy weight as a person gets older. As underweight increases the risk of bone loss, as obesity increases the burden on weight carrying bones, thus increasing the risk of falls.

Lack of exercise: Lack of regular exercise, such as walking, weakens bones and muscles, making them more prone to falls and fractures. So, starting a healthy practice of exercise can help you to keep your bones and muscles in strength.

Use of tobacco and alcohol: Both can disrupt the normal process of bone building and maintenance and lead to bone loss. Thus, avoidance is the best solution and prevention.

 

  • Classification of Femoral Head Fractures

 

Pipkin classification

Type 1:

Fracture inferior to the fovea capitis.

It can be treated conservatively in nondisplaced.

Type 2:

This fracture type separates the fovea capitis from the femoral head.

This fracture pattern is typically treated operatively.

Type 3:

Pipkin 1 or 2 plus femoral neck fracture 

Increased risk of AVN.

Percutaneous fixation in patients that are young, arthroplasty in preferred in older patients.

Type 4:

Pipkin 1 or 2 plus acetabular fracture     

Treatment depends on how the fragments of fracture are.

 

Radiology:

X-ray:

AP pelvis, hip series: Both before and after reduction.

Judet views: Related acetabular fracture

View of inlet and outlet: Related pelvic ring damage.

CT scan: usually done after reduction to assess the presence / size of loose bodies and fractures parts.

There are some findings of CT:

Fracture of the femoral head its size, position, location

Femoral head fracture level

Intra-articular fragment

Damage to the posterior pelvic ring

Impaction

Acetabular fracture

 

MRI is the first imaging modality of stress fractures, especially due to the excellent contrast of MRI when using proper pulse sequences, the inherent spatial resolution of modality, and the ability of MRI to image in multiple planes.

 

Garden classification:

This classification is based on AP radiography of the hip joint and determines and is used for prediction of development of avascular necrosis in view of femoral neck/head fractures. An orthopaedician Robert Symon Garden, a British surgeon, defined this classification. It consists of four stages:

•      Garden stage I: incomplete; not displaced. This includes impacted valgus fractures. In stage I, femoral neck trabecula on medial aspect may manifest a greenstick fracture.

•      Garden stage II: complete; not displaced. The medical trabeculae are intact and no disturbance is seen.

•      Garden stage III: not displaced fully; fracture is complete. In this stage, head of femur tilts into varus, which causes the medial trabeculae to come out of line (with trabeculae of pelvis).

•      Garden stage IV: complete displacement; fracture is complete. Position of femur head is placed in acetabulum normally.

Blood supply is most disrupted in stage III and IV. The treatment plan is to replace the bone that is fractured with arthroplasty (by placing prosthesis). Another way to treat is to have the fracture reduced and use metal screws to fix them. Garden I and stage II are fixed with screws, and stage III and IV is fixed with arthroplasty (in young people repairment is done by screws first, and then arthroplasty is done only if indicated).

 

Symptoms

  • Difficult to walk, or unable to walk, move legs, or stand.
  • Swelling of the lower back/hip area.
  • Severe hip or groin pain
  • Unable to put weight on the injured hip
  • Leg Bruises and swelling around the hip joint
  • Short legs on the side of the injured
  • Severe bruise or skin color change around the fracture.
  • Thigh muscle cramps.
  • Numbness and tingling in the thighs and legs.
  • Changes in the shape of the femur (deformation).

Fractures of the femur can be life-threatening as well and these mentioned symptoms should be checked to avoid any serious outcomes. These are:

  • Blood clots, pneumonia, and infections can lead to death after a femoral fracture.
  • Local swelling of the leg, or groin with redness and tenderness.
  • Fever, sweating, chills, or excessive fatigue.
  • Chest pain and / or dyspnea.
  • Severe or uncontrolled bleeding
  • A fragment of bone protruding from the skin.
  • Confusion or loss of consciousness.

 

Complications

There are a number of complications proposed after femoral head fracture and they are described as below:

 

  1. Heterotropic ossification:  This is an identified complications of femoral head fracture. Heterotropic ossification is often observed and of the formation of mature layered bone in extraskeletal soft tissue, which is normally bone-free. The patient population at risk of heterotropic ossification includes patients with burns, after trauma, traumatic amputation, joint replacement, etc. Lesions range from small clinically significant ossification lesions to large bone deposits that cause pain and dysfunction.

 

  1. AVN (avascular necrosis):Avascular necrosis of the femoral head is a debilitating condition that is an important condition that medical professionals need to be alert to for its symptoms. It can have a variety of causes of either traumatic or non-traumatic origin. These causes include fractures, dislocations, chronic steroid use, chronic alcohol use, coagulopathy, and congenital causes. Management of avascular femoral head necrosis can range from conservative to invasive. The exact treatment used depends on many factors like age, pain, necrosis, other comorbidities.

 

  1. Sciatic nerve neuropraxia: Damage to the sciatic nerve results from trauma to the nerve (pressure, extension, or amputation) and can cause symptoms such as paresthesia, weakness, and pain. These symptoms are similar to those caused by sciatica, but the term sciatica, is usually used to refer to a condition in which the sciatic nerve is inflamed and not due to some direct injury.

 

  1. DJD (degenerative joint disease): Patients show dysfunction due to joint pain, instability, and stiffness. Pain is usually exacerbated by activity and diminishes at rest. Many cases of radiological OA (osteoarthritis) are asymptomatic, and conversely, clinically apparent OA (osteoarthritis) may show no radiological changes.

 

 

  1. Decreased internal rotation: This is another complication of femoral head fracture. This happens due to another associated conditions with it and due to decreased movements in the course of trauma and treatment.

 

 

PEDIATRIC FEMORAL HEAD FRACTURE

Pediatric femoral head fractures accounts for <1% of all fractures in children. Most are caused by high-energy trauma from car accidents and fall from high places. Pathological fractures can result from low-energy trauma and, in rare cases, stress fractures due to repetitive activities such as running and jumping. Although this is a rare fracture, the fracture and its treatment are associated with significant long-term morbidity and complications due to the lack of blood supply in child and the anatomy of the bone.

Fractures of the head of the femur in children are rare injuries and are usually caused by high-energy trauma. Low energy trauma can lead to pathological head fractures and stress fractures of the neck due to repetitive activity. Surgery options may vary depending on age, classification of Delbet, and fracture displacement. Dislocated fractures are treated with closed or open reduction and fixation with cancellous or smooth screws. Some fractures require compression screws and side plate fixation. For younger children, fixation should be supplemented with immobilization with spica screws. The high incidence of complications is due to the anatomy of the blood vessels in the hip and proximal femur. Avascular necrosis, coxa vara (is a deformity of hip), premature physeal closure (PPC), and non-unions are the most common and often lead to adverse consequences.

 

Delbet classification:

This classification is named on Pierre Delbet, who was a French surgeon, and operated on femur head fractures. Pierre Delbet classified femur neck fractures into four types in adults, which is now known as Delbet's classification of fractures of proximal femur. This was adopted by Collona later on for fractures of the femoral head fracture in children. He used the classification to determine prognosis and treatment of fracture of hip in children.

This classification helps in prediction of risk of the avascular necrosis of head of femur in femur neck fractures. It also helps us to determine whether to use operative management or non-management.

 

•  Type I: separation of trans-epiphysis. Fracture is seen through proximal part of femoral physis, and represents SH I or Salter-Harris I fracture of femur (proximal part). It has two subtypes- IA (absence of dislocation), and IB (presence of dislocation).

 

•  Type II: fracture that is transcervical in nature. This type of fracture extends all the way via mid-portion of femur neck. It is the most common type of pediatric femoral head fracture.

 

•  Type III: fracture of cervicotrochanteric type. This fracture is seen through the base of femur neck.

 

•  Type IV: Fracture of intertrochanteric fracture. It is between the lesser and greater trochanters. It fractures type has the best result and outcome.

These patients are unable to put weight on their injured limbs.

The limbs may be shortened and may have limbs that are externally rotated, and the fracture may be associated with multiple other traumas (head trauma, abdominal trauma, etc.).

 

Diagnosis:

Plain x-rays are the primary diagnostic imaging method used to diagnose and classify femoral neck fractures in children. When taking lateral cross-table radiographs, care must be taken to move the uninjured limb so that the fracture on the injured side does not shift significantly. CT or MRI can play a role in simultaneous femoral neck fracture dislocation to better define the injury pattern.

 

Treatment:

Treatment has a wide range which goes from closed reduction, cast of spica to internal fixation and open reduction. An intervention known as Capsulotomy is recommended to take the intracapsular hematoma out and to decrease the risk of AVN (avascular necrosis) significantly.

Treatment plan depends on the type of fracture:

 

Type I:

•  Immobilization with spica cast and closed reduction: used for fractures that are minimally displaced or are non-displaced, for ages up to 4.

•  Internal fixation: it is feasible to be used for children who are of older age, or have fractures that are displaced. To get the anatomic alignment, open or closed reduction is done. For young children or those who are small, it is acceptable to use fixation by smooth pin. For children that are older, and for the adolescents, fixation with screws that are cannulated is recommended.

 

Type II, and Type III:

•  Immobilization with spica cast and closed reduction: used for fractures that are minimally displaced or are non-displaced, for ages up to 4.

•  Internal fixation: it is feasible to be used for children who are of older age, or have fractures that are displaced. To get the anatomic alignment, open or closed reduction is done. For young children or those who are small, it is acceptable to use fixation by smooth pin. For children that are older, and for the adolescents, fixation with screws that are cannulated is recommended. For these types, it may be necessary to cross the physis with cannulated screws to achieve the fixation we are planning to achieve. If the fixation doesn’t cross the physis, immobilization with spica cast should be recommended.

 

Type IV:

•  Immobilization with spica cast and closed reduction: fractures that are minimally displaced or not displaced at all for ages up to 3 or 4 years. To see if the reduction is enough and present within the cast, imaging of cross-sectional nature might be necessary.

•  Immobilization with spica cast, fixation with pins, or closed reduction: this type may be recommended for children up to the age of 6 years.

•  Internal fixation (rigid): for fractures that are displaced, in children who are of the age greater than 3. Anterolateral approach is necessary for open reduction or closed reduction. Hip screw compression or proximal femur plate.

Immobilization after surgery is dependent on the type of fracture, the age of patient, and the treatment plan. It is recommended to use spica cast for 8-10 weeks for children who cannot bear the technique of non-weightbearing or partial weight bearing. Those adolescents who have rigid fixation can start to take partial weight bearing within 2 weeks of the intervention.

 

Complications:

 

  1. Avascular necrosis: AVN is the most serious and unfortunately the most common complication after femur head fracture. It is seen that the risk and incidence of AVN or vascular necrosis is higher in Delbet type I fracture (also known as transepiphyseal fractures), particularly if the fracture is related with displacement of hip or the fracture is dislocated. The first initial manifestations of AVN are limited range of motion and pain. Bone scan is recommended at 3 and then 12 months after injury to detect AVN. AVN is further classified into three subtypes; type I has whole femur head involvement and has the worst prognosis, type II involves on one portion of head, and type III has necrosis within a zone of AVN.

 

  1. Nonunion: it is seen to occur in 6-10% of all hip fractures related to children (pediatric hip fractures). If anatomical reduction is not able to be achieved, or if it cannot be maintained nonunion occurs. It is necessary to use valgus osteotomy to achieve a union that is secondary. In children, strut grafts of fibula are used to treat femoral neck fracture nonunion.

 

 

  1. Premature physeal closure: or PPC has been seen related to avascular necrosis (AVN).

 

4. Coxa Vara: it is second common and serious complication of femoral head fracture after avascular necrosis (AVN). The incidence and risk are low in those who are treated surgically. In children who are under 8 years of age the treatment plan is epiphysiodesis of femur greater trochanter.

 

 

Femoral head fracture recovery

Femoral head fracture usually takes 12 weeks to 12 months for recovery. But alongside treatment and even after surgery, you may need to see your physiotherapist after sometime to involve the leg into some motion to avoid complications that can be prevented. Most people who experience a femur fracture can begin to walk with the help of a physiotherapist in the day one or two after injury and/or surgery. You can start after 1-2 weeks, the physiotherapy program that will focus on controlling the complains of pain and later on gradually starts to improve the range of movement. Treatment includes gentle passive and active movements, and correcting the gait using assisted techniques.

 

Femoral head fracture treatment

Hip fracture dislocation is a real orthopedic emergency. In the absence of contraindications (e.g., associated femoral neck fracture), there is a direct relationship between delayed reduction and increased risk of femoral head necrosis, so urgent reduction is performed as soon as possible, preferably 6 hours. A femoral head fracture with a dislocation or a femoral neck fracture is a sign of urgent open reduction. In these situations, preoperative CT scans should be done at the right time, if possible. The goals of curative treatment for femoral head fractures are anatomical reduction, achievement and maintenance of joint stability, and removal of temporarily conserved bone fragments. This can be achieved non-surgically or surgically. Fracture size, location, and displacement are factors in this decision-making process.

First treatment Fractures in the head of the thigh usually make it impossible to walk because of the pain. You will probably have to be taken to the emergency room for examination and complete evaluation.

The emergency room will perform x-rays and / or CT scans of the hips and pelvis. People with femoral head fractures are often hospitalized for observation and pain management. These injuries often require surgical treatment.  Sometimes an injury may temporarily require what is known as "skeletal traction". This is where the weight is attached to the leg via a pin inserted into the bone. It can relieve pain by reducing muscle spasms, re-adjusting fractures and reducing the strain on the fractured bones.

 

General treatment:

The ultimate goal of treating these fractures is to return the function of joint to normal level or around it or return the femoral head to the socket. Factors such as age, general health, and smoking status can also affect the management of these fractures.

Less serious femoral head fractures may be treated without surgery. Non-surgical treatment includes using crutches, a walker, or a wheelchair to avoid putting weight on the legs. If surgery is required for a fracture, it is done under anesthesia.

 In some cases, the fracture is so severe that the surgeon cannot undo the damage he suffered during the injury. In this case, the best behavior may be to perform total hip arthroplasty (arthroplasty).

 

Postoperative care:

The most important thing after surgery is to give the bone time to heal. This may mean little or no strain on the hips and legs and may require the use of crutches, or wheelchairs.

You will have to work with a physiotherapist to restore strength and function. Anticoagulants may be given after surgery to reduce the possibility of blood clots. Anticoagulants and early exercise are important to prevent blood clots. Several painkillers are used for postoperative pain with the aim of minimizing the number of opioids needed.

Usually, a few weeks after surgery, you will have to see your doctor again and x-rays may be needed to ensure that everything continues to heal properly. It is very important to follow the instructions of the treating surgeon.

 Treatment can also be defined as follows:

Non-operative care includes observation alone and is considered in patients who carry risk for any surgical intervention or have minimal pain.

Operative care includes ORIF, cannulated scree fixation, sliding hip screw, hemiarthroplasty and total arthroplasty.

 

ORIF (open reduction and internal fixation): is indicated in patients who are young and physiologically with displaced fractures and involves patients less than 50 years of age usually.

 

Cannulated scree fixation: is indicated in patients with non-displaced transcervical fracture and in patients with displaced fracture who are young and is considered as a surgical emergency and reduction should be achieved to limit the vascular complications.

 

Sliding hip screw: This type of procedure is indicated in Basi cervical fracture and vertical fracture in young people and using additional screws to prevent rotation.

 

Hemiarthroplasty:  This procedure indicated in debilitated patients and particularly patients, and with some underlying medical diseases like metabolic bone disease, but is still controversial.


Total arthroplasty: This procedure is also controversial, and is indicated in patients who are elderly and are active. Patients with pre-existing and underlying diseases like osteoarthritis will have to undergo this procedure.

 

Takeaway:

Fractures of the femoral head, are injuries that are to be taken seriously because they affect the joints that support all weight. Complications of femoral head fractures include infections, blood clots, and persistent pain. Bone may not heal properly or at all. Necessary prevention and proper care and management in due age and time and help you avoid falling into this miserable condition of femoral head fractures and its enormous complications. Complications though inevitable but with the help of your doctor are manageable.

 

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