Femoral Head Fracture

Physical Therapy Videos - Hip and Pelvis

Basic Anatomy

Your femoral head is the upper "ball" part of your thigh bone (femur) that fits into the "socket" part of your hip joint that is part of your pelvis. It is covered by cartilage. This helps your hip joint move easily without friction. This part of your femur is made of some of the strongest bone in your body. All the force that travels between your spine and legs in order to walk or move actually passes through your hip joint. Bumps in the bone called "trochanters" are where muscles attach to help you move your leg. Your femoral neck and femoral head are contained within a pocket known as the "hip joint." The femoral head and neck are separated from the rest of your femur and surrounding muscles by the hip "joint capsule." This hip capsule limits the blood supply a bit, but blood supply is generally very important to keep bones healthy and strong, and to help them heal after a break. If the capsule is extensively torn the fracture may take longer to heal or not heal at all.

Graphical picture of a femur. — Figure 1: Model of a femur.

Figure 2: X-rays showing the location of the femoral head.

Mechanism and Epidemiology

Femoral head fractures can happen after many types of incidents. They can happen during a high-energy sports collision, or a direct trauma such as a motor vehicle collision or motorcycle crash. These high-energy injuries are not common and require specialized care.

Figure 3: Example of a femoral head fracture on CT scan.

Figure 4: An extreme example of a femoral head fracture, in which the piece was flipped the wrong way. This is a surgical emergency.

Initial Treatment

If you sustain a femoral head fracture, you will usually not be able to walk on your leg due to pain. You will likely be taken to an emergency room for evaluation.

At the emergency room, you will have x-rays and/or a CT scan taken of your hip and pelvis. People with femoral head fractures are often admitted to the hospital for observation and pain control. Often, these injuries will require surgical treatment.

Sometimes, the injury may temporarily require what is known as “skeletal traction”. This is where a weight is attached to your leg via a pin placed into your bone. This can help with your pain by reducing muscle spasms, realigning your fracture, and taking pressure off your broken bone.

General Treatment

The final goal for treating these fractures is to make the ball of your hip joint smooth or make the hip head back into a ball. How this happens depends on the shape and location of your fracture. Factors like age, overall health, and smoking status may also impact how these fractures are treated.

Less critical femoral head fractures can sometimes be treated without surgery. Non-surgical treatment includes keeping the weight off your leg by using crutches, a walker, or a wheelchair.

If your fracture requires surgery, it will be done under anesthesia. Your fracture may require a surgical hip dislocation, in which your surgeon moves your hip joint out of the socket to get at the broken pieces. The pieces are fixed, and if there are other broken bones of the hip joint, they are generally fixed as well. Some pieces may just be removed.
In some instances, the fracture can be severe enough that a surgeon cannot undo the damage that has been done at the time of your injury. In this event, the best course of action may be to perform a total hip replacement (arthroplasty). The surgeon who performs the hip replacement may or may not be the same person that performs the fracture surgery.

Figure 5: A femoral head fracture fixed with screws.

A femoral head fracture and a hip socket fracture fixed with plates and screws. — Figure 6: A femoral head fracture and a hip socket (acetabular) fracture fixed with plates and screws.

Post-operative Care

After surgery, the most important thing is giving your bones time to heal. During this time, it is very important to follow the instructions of your surgeon. This may mean putting little to no weight on your hip and leg, and may require using crutches, a walker, or a wheelchair.

You may work with a physical therapist to rebuild strength and function. You may be placed on a blood thinner after surgery to decrease your chance of getting a blood clot. Blood thinners and early movement are important in preventing blood clots. Several pain medications will be used for your postoperative pain, with the goal of minimizing the amount of narcotics (opioids) you need to take.

You will typically return to see your surgeon or their staff a few weeks after surgery. From that point in time, the visits will generally become less frequent, but you will need occasional x-rays to make sure everything continues to heal properly. It is extremely important to follow instructions provided by your treating surgeon. If you have questions, ask your surgeon or their staff.

Long Term

Femoral head fractures are severe injuries because they involve a joint that bears all your weight. Complications after femoral head fractures may include infections, blood clots, and persistent pain. Sometimes the bones do not heal correctly, or may not heal at all. Poor blood supply may cause the bone to not heal or erode away (avascular necrosis). You may also develop arthritis in your hip joint. These complications may require medications, hospital stays, another surgery, or a hip replacement. Complications can still occur even if you do everything "right," but following the instructions of your surgeon can help minimize the risk.