Symptoms of femoral head fracture, these common manifestations

Femoral head fractures are generally caused by strong violence, which is especially common among the elderly. They can cause symptoms of comminuted fractures and the pain is particularly obvious. They require timely treatment and scientific care, otherwise they will cause complications of ischemic necrosis.

1. Common symptoms

Patients with femoral head fractures experience swelling and severe pain in the affected hip, and the function of the affected hip is severely limited due to the pain. This fracture is often accompanied by hip joint injury, so there may be signs of posterior hip dislocation, lower limb flexion, adduction, external rotation deformity, elastic fixation, limb shortening or anterior hip dislocation.

II. Treatment

1. Non-surgical treatment: For patients with fractures not accompanied by hip dislocation, if the fracture fragments have no obvious displacement or compression, non-surgical treatment can be performed. After resting in bed for 3 weeks, the patient can get up with crutches and not bear weight on the injured limb. Giebel believes that long-term traction should be avoided, otherwise it is easy to cause ischemic necrosis of articular cartilage and joint stiffness. Fractures accompanied by dislocation should be reduced immediately. Anesthesia should be sufficient during reduction, and violence should be avoided. Strive for a successful reduction in one go. If it fails for two consecutive times, surgery should be considered. After reduction, take an X-ray to understand the reduction situation, and do a CT scan to clarify the position, size and displacement of the fracture fragments.

2. Surgical treatment: If the fracture fragments are obviously collapsed, displaced, embedded in the joint space, accompanied by dislocation and manual reduction fails or there is nerve damage, open reduction should be performed immediately.

Select the anterolateral or posterolateral approach according to the location of the fracture fragment, expose the hip joint and dislocate the femoral head from the acetabulum. If the bone fragment is small, it can be removed. If the fracture fragment is large, it should be repositioned and fixed with screws. When the fracture fragment is large and thick, a cancellous bone traction screw can be inserted retrogradely through the extra-articular part of the femoral head. If there is difficulty, only the absorbable screw can be drilled antegradely, and the screw head should be lower than the cartilage surface. If the fracture part collapses, it should be pried up and padded with autologous cancellous bone. If the collapse range exceeds half of the weight-bearing surface of the joint, and the comminuted fracture is difficult to fix internally or is combined with a femoral neck fracture, joint replacement should be considered. After the operation, it should be repeatedly flushed before suturing to avoid leaving cartilage or bone fragments. Negative pressure drainage should be left in place for 24 to 48 hours.