Fractures of the femoral head: what are the reasons for poor outcome?

BACKGROUND
In this article, we aimed to discuss treatment strategies in fracture of the femoral head, which is a very rare injury.
METHODS
We reviewed five patients (six fractures) who admitted to our emergency department due to femoral head fracture between March 2006 and December 2007. Functional outcomes of the patients who were treated operatively and nonoperatively were compared.
RESULTS
Half of the fractures were treated nonoperatively and half of them surgically. We observed a rate of 50% excellent to good results. Avascular necrosis developed in a patient with bilateral injury. The functional results were poor for this patient. Early posttraumatic arthritis was observed in a patient who was treated surgically; this patient had moderate results.
CONCLUSION
We should aim at anatomic reduction of the fragments with minimum soft tissue injury. The best approach should be chosen for excellent view of the fragments. We should not forget that half of these patients will have a poor outcome despite all treatment strategies.

Femur baþý kýrýklarý: Tedavi stratejisi ne olmalýdýr?

AMAÇ
Bu yazýda, çok nadir bir yaralanma olan femur baþý kýrýklarýnda tedavi stratejilerinin tartýþýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Mart 2006 ile Aralýk 2007 arasýnda acil servise femur baþý kýrýðý ile baþvuran beþ hastanýn altý kýrýðý incelendi. Cerrahi ve cerrahi dýþý yöntemlerle tedavi edilen hastalarýn fonksiyonel sonuçlarý karþýlaþtýrýldý.
BULGULAR
Hastalarýn yarýsý cerrahi yöntemle, yarýsý da cerrahi dýþý yöntemlerle tedavi edildi. Mükemmel ve iyi sonuçlarýn oraný %50 bulundu. Ýki taraflý yaralanmasý bulunan hastada avasküler nekroz geliþti. Bu hastada fonksiyonel sonuçlar kötü bulundu. Cerrahi ile tedavi edilen hastalardan birinde erken posttravmatik artrit görüldü, bu hastanýn fonksiyonel sonuçlarý orta bulundu.
SONUÇ
Minimum yumuþak doku travmasý ile anatomik redüksiyonun saðlanmasý bu kýrýklarýn tedavisindeki amacýmýz olmalýdýr. Parçalarýn en iyi görüntüsü hangi yaklaþýmla saðlanacaksa o yaklaþým tercih edilmelidir. Þu unutulmamalýdýr ki, tüm tedavi seçeneklerine raðmen bu hastalarýn fonksiyonel sonuçlarý kötü olabilmektedir.