Fractures of the femoral head.

Fractures of the femoral head infrequently accompany hip dislocations, but create complex therapeutic dilemmas for the orthopaedist when they do occur. The difficulties are compounded by existing incomplete classification schemes, which do not satisfactorily predict the final clinical results of a given injury or treatment. This chapter encompasses an extensive literature review of 238 published cases and analyzes the areas of confusion concerning this group of injuries. Our experience with 27 cases of femoral head fracture is presented. These examples emphasize the need for prompt, concentric reduction of the hip joint followed by individualized treatment of each type of femoral head fracture. An improved classification system to eliminate the ambiguities of previous systems and to provide the clinician with treatment guidelines for each type of femoral head fracture is proposed. These guidelines should improve the final results in these difficult and rare injuries.