Fracture of the Femoral Head: Causes, Symptoms & Treatment

Under a femoral head fracture, the medical profession refers to a fracture of the head of the femur. That fracture occurs very rarely; often only in combination with an acetabular fracture or dislocation of the hip joint. For that fracture to occur, an enormous force must be applied from the outside. Prevention is usually not possible.

What is a femoral head fracture?

The femoral head is located at the upper end of the femur. This is enclosed by the acetabulum. Thereby, the femoral head and the acetabulum form the ball and socket joint of the hip. Due to its shape, the ball and socket joint also guarantees the enormous freedom of movement that humans enjoy. This is because the thigh can very well be moved in all possible directions. In order for this movement to be guaranteed, an optimal function must take place between the femoral head and the acetabulum, which is also covered with a cartilaginous sliding layer. This can be compared to a shock absorber. The joint capsule provides a seal for the joint and subsequently produces fluid, which is necessary for the cartilage to move smoothly. According to Pipkin, who classified the femoral head fracture, depending on the accompanying symptoms and location, the fracture is divided into four types:

  • Type I: In this case, a fracture occurs below the so-called foveacapitis femoris; thus, the fracture occurs outside the designated loading zone.
  • Type II: The fracture of the femoral head occurs above the designated loading zone; the physician refers to a fracture that is in combination with the fovea capitis.
  • Type III: Sometimes a type I or type II, but in combination with a medial femoral neck fracture.
  • Type IV: Type I or type II associated with a fracture of the acetabulum.

Causes

Fracture of the femoral head occurs predominantly when there is a tremendous amount of force. In particular, external force or falls can trigger a corresponding injury. However, femoral head fractures are relatively rare; especially the pure fractures – without combination with a femoral neck fracture or a fracture of the acetabulum – occur in only a few of all cases.

Symptoms, complaints, and signs

The patient complains predominantly of very severe pain. Furthermore, there is a restriction of movement that forms primarily on the affected side. The patient cannot walk or stand – in the context of such an injury. If it is a type III, shortening of the external rotation of the legs can also occur. Such shortening is also possible in the case of a type IV injury. In the context of such a fracture, it is important that immediate medical attention is given. The patient must be treated by a doctor as soon as possible. This is mainly because the affected person not only has to endure enormous pain, but it is also important which therapy the medical professional decides on. This is ultimately responsible for whether and to what extent consequential damage remains or a 100 percent cure can take place. In almost all cases, surgical treatment is performed; only in the case of type I injury can it be assumed that the medical professional will opt for conservative therapy.

Diagnosis and course of the disease

The medical professional begins with a physical examination. Here, attention is paid predominantly to what pain the patient indicates and whether there is a restriction of mobility. The physician is also primarily interested in whether the patient fell or whether the force was external – such as a car accident (impact). In order for the physician to be sure that it is a fracture of the femoral head or what type it is, X-rays are taken. Sometimes computed tomography scans may also be ordered so that the injury and type can be confirmed. Normally, however, physicians can already tell by x-ray that there is a fracture or what type it is.

Complications

The fracture of the femoral head causes the patient to have significant limitations in movement. In most cases, however, this fracture does not occur alone, but is accompanied by other fractures and injuries to the hip and usually to the entire body. The patient thus suffers from severe restrictions in everyday life.Often there is also a shortened rotation of the legs, which has an equally negative effect on the movement of the affected person. The femoral head fracture leads to extremely severe and stabbing pain. It is not uncommon for patients to faint immediately after the accident and for this reason require immediate treatment. The pain also occurs in the form of pain at rest and can negatively affect the patient’s sleep. It cannot be guaranteed that the patient will heal completely. In many cases, movement restrictions and other complaints continue to occur even after treatment. The patient’s ability to cope with stress is significantly reduced and it is often no longer possible to perform any sporting activities. During the treatment itself, there are usually no particular complications. This takes place through surgical intervention and alleviates the discomfort. Not infrequently, prostheses or an artificial joint are required.

When should you go to the doctor?

Because a fracture of the femoral head is a fracture of the bone, it must be examined and treated in any case. There is no self-healing and usually false fusion if this fracture is not treated by a doctor. The doctor should be consulted if there is very severe pain in the affected region. As a rule, the pain is associated with restricted movement. Especially after an accident or after a violent blow, these complaints may indicate the fracture of the femoral head and should be examined by a doctor. In some cases, the pain can be so severe that the person loses consciousness and faints. In that case, an emergency physician should be called or the affected person should be transported to a hospital. Treatment of the femoral head fracture is usually done by surgery. This does not result in any particular complications, so the life expectancy of the affected person is also not negatively affected by the fracture.

Treatment and therapy

Which therapy is chosen depends primarily also on the location of the fracture, the accompanying symptoms, and the age of the patient. If a type I fracture is present, reduction of the femoral head is performed. This involves creating an exact adaptation of the fragments. This is a classic conservative therapy. In most cases, surgery is not performed for type I fractures. In the case of type II fractures, on the other hand, screws are used to fix the fracture. This is called osteosynthetic screw fixation; the femoral head is reinforced with screws. This therapy can only be performed surgically. In the case of type III or IV fractures, the age of the patient plays an important role. In younger patients, the so-called osteosynthetic treatment is performed, if possible. In older patients, a hip joint endoprosthesis is usually used. This is intended to remedy any persistent complaints that may have arisen as a result of the accident. Above all, the hip joint endoprosthesis has – in the case of older patients – provided for successful therapies. It is important that – no matter which type has been diagnosed in the patient – physiotherapy is practiced so that, on the one hand, the femur can be strengthened and, on the other hand, any mobility restrictions can be prevented.

Prevention

Fracture of the femoral head cannot be prevented. Since that injury is formed in the context of an accident, it can predominantly only be said that caution is advised and falls should be avoided. There is no prescription for the prevention of such a fracture.

Aftercare

Accidents and tremendous force cause a fracture of the femoral head. They occur purely by chance. Thus, unlike tumor disease, follow-up care cannot prevent the reoccurrence of symptoms. Early diagnosis is not an option due to the acute trigger. Nevertheless, scheduled follow-up examinations are due. The therapy framework gives reason for this. Older persons in particular often require long-term treatment due to their reduced physical regenerative power. Follow-up care primarily involves physical therapy. In the exercise sessions, the musculature is strengthened and mobility restrictions are remedied. This is followed by self-administered regeneration sessions at home. Follow-up care generally includes mandatory appointments in which the progress of the disease is analyzed.Such a procedure is also indicated for a fracture of the femoral head. For this purpose, the physician and patient agree on an individual rhythm that corresponds to the complaint situation. In addition to a detailed physical examination, imaging procedures are important in assessing the course of the disease. X-rays in particular, but also computer tomography, guarantee a clear diagnosis. Motor function and blood circulation are also assessed by the physician. The comprehensiveness of the survey is based on the fact that a fracture of the femoral head can develop into arthrosis. This unfavorable complication is to be avoided in any case.

This is what you can do yourself

In the case of a femoral head fracture, the patient tries to improve the chances of success of the surgical procedure by taking supportive measures. Immediately after surgery, the patient is encouraged to maintain a resting position and avoid stress on the hip and the entire musculoskeletal system. During this phase, the patient is usually closely monitored by a doctor, and the patient must follow all advice given by the doctor and nurses. Stress and excitement should be avoided, and a healthy diet also aids the body’s recovery after surgery. As soon as the patient returns to his usual living environment after inpatient treatment, he continues to show consideration for his limited mobility. The patient avoids excessive physical strain and allows himself sufficient rest to promote healing. In addition, he pays attention to adequate wound care and enlists the help of others for physically strenuous activities. Unpleasant after-effects of the operation in the hip area can be alleviated by means of ointments and pain medication recommended by a doctor. This is usually followed by physiotherapeutic treatment to restore mobility, with the patient positively influencing the chances of recovery by regularly performing the prescribed exercises at home. Additional exercise sessions are often possible, and these must be coordinated with the therapist in each case.