Fracture of the femoral head usually results from high-energy trauma, particularly motor vehicle accidents. These fractures are often associated with poor functional outcomes. SF-36 and MFA scores were obtained for twenty-five femoral head fractures. The mean SF-36 scores was 57.2 (22.6 to 82) and the mean MFA score was 37.6 (10–72). As expected the scores were negatively correlated (−0.587, p=0.005). The presence of an ipsilateral posterior acetabluar wall fracture negatively affected functional outcome. Fragment excision was associated with a higher functional outcome when compared to internal fixation. Posterior surgical approach resulted in higher scores than patients who underwent an anterior procedure.

Fracture of the femoral head is a rare but severe injury. The purpose of this study is to determine the functional outcome of and prognostic factors associated with femoral head fractures.

Acetabular wall fracture, surgical approach, and method of surgical treatment are prognostic factors of functional outcome as measured by the SF-36 and the MFA.

There is currently no consensus on the management of femoral head fractures and treatment practices have evolved on the basis of a limited series of studies. Functional outcome following femoral head fracture has been evaluated using Epstein’s criteria in several studies, however, only one study has been conducted using a validated outcome measure.

Twenty-five femoral head fractures in twenty-four patients were identified from the trauma and orthopaedic databases of two major trauma centres. The patient with bilateral femoral head fractures was not included in the analysis. After obtaining informed consent, the patients’ medical records were reviewed. Functional outcome was assessed using two validated, patient-based outcome measures, the Short Form (SF)-36 and the Musculoskeletal Functional Assessment instrument (MFA). The average age of the patients was 36.8 (std. dev. 11.1) and the mean length of follow-up was 41.4 months (minimum twelve months). Three factors were identified using non-parametric analysis that significantly affected the functional outcome scores:

The presence of an ipsilateral posterior acetabluar wall fracture negatively affected functional outcome (p=0.08).

The purpose of this study was to evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome. One hundred and fifteen patients were identified. 63% were male; mean age was thirty-seven years; mean ISS was thirty. Three patients died from their injuries. At a mean follow-up of 3.5 years, patients exhibited profound functional deficits compared to the normal population. Those with an acetabular fracture involving the posterior wall or an associated lower extremity injury have a particularly poor prognosis. Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment.

To evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome.

Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment.

These results will allow us to further investigate which injury is dictating prognosis in the combined injury – the pelvic or the acetabular fracture.

One-hundred and fifteen patients with combined pelvic and acetabular injuries were identified at a level One trauma centre. 63% were male; mean age was thirty-seven years (13–88); mean ISS was thirty (16–75). Three patients died from their injuries. 16% involved bilateral pelvic fractures; 7% bilateral acetabular fractures; and for 2%, both were bilateral. 64% were Tile B and 34% were Tile C. Most acetabular fractures involved the anterior column or both column. Only 18% were treated with ORIF for both injuries. 25% had ORIF of their acetabulum and 14% had ORIF on their pelvis. Sixty-five patients completed validated functional outcome questionnaires at a mean follow-up of 3.5 (one to eleven) years. Patient function was significantly compromised with a mean MFA score of 33.8 (SD 21.8). Function was worse for all 8 SF-36 domains and the two component scores compared to the health status of the Canadian normal population (p< 0.001). Those individuals with an acetabular fracture involving the posterior wall or an associated lower extremity injury have a particularly poor prognosis. There was no relationship found between treatment or the pre-defined stability groups and functional outcome.

Funding: Grant funded from AO/ASIF

The purpose of this study was to evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome. One hundred and fifteen patients were identified. 63% were male; mean age was thirty-seven years; mean ISS was thirty. Four died from their injuries. Five patients had open injuries. Only 18% were treated with ORIF for both injuries. At a mean follow-up of 3.5 years, patients with combined pelvic and acetabular fractures exhibit profound functional deficits compared to the normal population. Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment.

The purpose of this study was to evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome.

Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment. Those individuals with an acetabular fracture involving the posterior wall and an associated lower extremity injury have a particularly poor prognosis.

Individuals who have sustained high energy combined injuries exhibit profound functional impairments compared to the general normal population even in the long term.

One hundred and fifteen patients with combined pelvic and acetabular injuries were identified using a trauma database at a level one trauma centre. 63% were male; mean age was thirty-seven years (13–8); mean ISS was thirty (9–5). 16% involved bilateral pelvic fractures; 7% bilateral acetabular fractures; and for 2%, both were bilateral. 64% were Tile B and 34% were Tile C. Most acetabular fractures were anterior column (31%) or both column fractures (26%). Only 18% were treated with ORIF for both injuries. 25% had ORIF of their acetabulum and 14% had ORIF on their pelvis. Sixty-five patients completed functional outcome questionnaires at a mean follow-up of 3.5 years (1–21). Function was significantly compromised with a mean MFA score of 33.8±21.8. Function was worse for all eight SF-36 domains and the two component scores compared to the Canadian normal population (p< 0.001). There was no relationship found between severity of pelvic or acetabular injury and patient function nor between treatment and functional outcome.

Funding: Grant funded from AO/ASIF