Session II - Femur

Thurs., 10/5/06 Femur, Paper #6, 3:30 pm

Functional Outcome of Femoral Head Fractures

Kurt P. Droll, MD (n); Gavin Pereira, MD (n); Henry Broekhuyse, MD (n); Robert N. Meek, MD (n); Piotr A. Blachut, MD (n); Pierre Guy, MD (n);
Peter J. O'Brien (n);
University of British Columbia, Vancouver, British Columbia, Canada

Purpose: Fractures of the femoral head are relatively uncommon injuries and usually occur following a traumatic dislocation of the hip joint. The purpose of this study was to evaluate self-reported functional outcome of patients who have sustained a femoral head fracture.

Methods: A search of the trauma database at a Level I trauma center between 1987 and 2003 was conducted. 68 patients sustaining 69 femoral head fractures were identified. Two patient-based outcome measures, the Short Form-36 (SF-36) and Short Musculoskeletal Functional Assessment (SMFA) were used to evaluate functional outcome. Two subjects were ineligible for follow-up due to a severe head injury and contralateral leg amputation respectively.

Results: 35 (51%) fractures were classified as Pipkin type I, 22 (32%) type II, 3 (4%) type III, 8 (12%) type IV, and 1 (1%) had associated fractures of both the femoral neck and acetabulum. Mechanism of injury included motor vehicle accident (52/69), falls (14/69), crush injury (2/69) and unknown (1/69). The mean age was 35.2 ± 14.3 and ISS 13.0 ± 8.8. 49 hips were treated operatively (37 internal fixation, 7 excision, 5 open reduction only). Operative treatment was performed through anterior approach (29/49), posterior approach (19/49), and combination (1/49). 13 hips failed initial treatment and required delayed total hip arthroplasty (THA, 11/13), hemiarthroplasty (1/13), or vascularized fibular graft (1/13). Reasons for failure included osteonecrosis (7/13) and posttraumatic osteoarthritis (6/13). 30 subjects (18 male) with 31 femoral head fractures have complete functional outcome data. The mean follow-up for this subgroup was 9.6 ± 5.5 yrs. These subjects (n = 23 without THA) scored poorer than age-matched population norms for the SF-36 physical component score (mean 44.6, P = 0.008) and dysfunction index of the SMFA (mean 55.2, P = 0.01).

Conclusion/Significance: This is the first report of SF-36 and SMFA functional outcome data following treatment of femoral head fractures. Physical function was significantly lower when compared to population norms.

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· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.