STUDY OF THE TREATMENT OF FEMORAL HEAD FRACTURES.

OBJECTIVE: To establish guidelines for the treatment of femoral head fractures and to determine the best form of access in cases treated surgically. METHODS: We evaluated the clinical and radiological results from 13 patients (13 fractures) treated surgically, between May 1986 and July 1996, at the Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de Sao Paulo (SCMSP), Fernandinho Simonsen Wing. RESULTS: Out of six cases of Pipkin 1 fractures, five underwent resection of the fragment, resulting in four excellent and one good result. The good result had fixation of the fragment. Three patients presented Pipkin 2 fractures and all of them had fixation of the fragment, resulting in two excellent and one regular result. Two patients had Pipkin 3 fractures and underwent primary arthroplasty. Among the two patients with Pipkin 4 lesions, one was treated with reduction and osteosynthesis of the acetabular fracture, without addressing the head fragment, which had reduced significantly, resulting in early arthrosis; and the other patient was treated with total arthroplasty as the primary treatment. CONCLUSION: Upon comparing the literature review and our patients' treatment results, we concluded that femoral head fracture treatment needs to be surgical and that the choice of surgical access depends on the type of fracture.

ANALYSIS OF THE SEGMENTAL IMPACTION OF FEMORAL HEAD FOLLOWING AN ACETABULAR FRACTURE SURGICALLY MANAGED.

OBJECTIVE: Correlate the postoperative radiographic evaluation with variables accompanying acetabular fractures in order to determine the predictive factors for segmental impaction of femoral head. METHODS: Retrospective analysis of medial files of patients submitted to open reduction surgery with internal acetabular fixation. Within approximately 35 years, 596 patients were treated for acetabular fractures; 267 were followed up for at least two years. The others were excluded either because their follow up was shorter than the minimum time, or as a result of the lack of sufficient data reported on files, or because they had been submitted to non-surgical treatment. The patients were followed up by one of three surgeons of the group using the Merle d'Aubigné and Postel clinical scales as well as radiological studies. RESULTS: Only tow studied variables-age and amount of postoperative reductionshowed statistically significant correlation with femoral head impaction. CONCLUSIONS: The quality of reduction-anatomical or with up to 2mm residual deviation-presents a good radiographic evolution, reducing the potential for segmental impaction of the femoral head, a statistically significant finding.