Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 21;22(1):810.
doi: 10.1186/s12891-021-04703-w.

Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification

Jichao Liu  1 , Zhengwei Li  1 , Jie Ding  2 , Bingzhe Huang  1 , Chengdong Piao  3
Affiliations

Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification

Jichao Liu et al. BMC Musculoskelet Disord. .

Abstract

Background: Femoral neck fracture combined with anterior dislocation of the femoral head is very rare. To our knowledge, there is no classification system yet for this rare form of injury, and the injury mechanism of femoral neck fracture combined with obturator head dislocation has not been described in the literature. In this study, we systematically reviewed the literature and the cases treated in our hospital, and identified and classified all injury types according to the injury mechanism of femoral neck fracture combined with anterior dislocation of the femoral head. Further, based on the experience of treating a patient with femoral neck fracture and obturator dislocation of the femoral head, a theoretical hypothesis was proposed for the injury mechanism of this rare type of injury.

Methods: A comprehensive search was conducted on PubMed, WOS, CNKI database. These fractures were classified according to the dislocation site and injury mechanism (one injury or two injuries).

Results: 1891 articles were initially identified through PubMed and other databases, and after bibliographic research, study screening, and removing duplicates, 1455 articles were selected. After applying the exclusion criteria, a total of 18 full-text articles describing femoral neck fractures combined with anterior dislocation of the femoral head. Different dislocation sites have different injury mechanisms. Our classification system, to the best of the authors' knowledge, allowed us to include all types of femoral neck fractures combined with anterior dislocation of the femoral head from the literature. According to the proposed classification system, the morphological features of femoral neck fracture combined with anterior dislocation of the femoral head can be accurately conveyed between doctors.

Conclusions: All injury patterns can likely be identified using the proposed classification system. This can help avoid confusion in the nomenclature of femoral neck fractures combined with anterior dislocation of the femoral head and help surgeons to more accurately detect lesions, thereby guiding surgical treatment.

Keywords: Classification; Femoral neck fracture; Hip dislocation.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of literature selection
Fig. 2
Fig. 2
Comprehensive injury-mechanism-based classification system. (I)Type I: Pauwels angle is <30°, and shows no dislocation of the femoral head. (II)Type II: Pauwels angle is between 30°–50° and shows no dislocation of the femoral head. (III)Type III: Pauwels angle is >50° and shows no dislocation of the femoral head. (IV)Type IV: Pauwels angle is >50°, and is accompanied by anterior dislocation (obturator subluxation, anterior pubic dislocation, and subpubic dislocation); this is the result of only one impact. (V)Type V: Pauwels angle is >50° and accompanied by obturator dislocation of the femoral head or pelvic dislocation. This is the result of two injuries
Fig. 3
Fig. 3
Injury mechanism of femoral neck fracture combined with obturator dislocation. The inner side of the proximal femur hits the outer and upper parts of the femoral head. After the second impact, the femoral head dislocated to the obturator through the sartorius tunnel and was blocked by the pubic branch, resulting in a fracture of the inferior pubic branch, which eventually caused the femoral head to be embedded in the obturator
See this image and copyright information in PMC

References

    1. Zetterberg C, Elmerson S, Andersson GB. Epidemiology of hip fractures in Göteborg, Sweden, 1940-1983. Clin Orthop Relat Res. 1984;(191):43–52. - PubMed
    1. Hedlund R, Lindgren U, Ahlbom A. Age- and sex-specific incidence of femoral neck and trochanteric fractures. An analysis based on 20,538 fractures in Stockholm County, Sweden, 1972-1981. Clin Orthop Relat Res. 1987;(222):132–9. - PubMed
    1. El Masry AM. Anterior hip dislocation with ipsilateral displaced fracture neck of femur treated by open reduction and internal fixation: case report and review of the literature. Strategies Trauma Limb Reconstr. 2017;12(3):205–210. doi: 10.1007/s11751-017-0292-8. - DOI - PMC - PubMed
    1. Scolaro JA, Marecek G, Firoozabadi R, Krieg JC, Routt MLC. Management and radiographic outcomes of femoral head fractures. J Orthop Traumatol. 2017;18(3):235–241. doi: 10.1007/s10195-017-0445-z. - DOI - PMC - PubMed
    1. Pascarella R, Fantasia R, Sangiovanni P, Maresca A, Massetti D, Politano R, Cerbasi S. Traumatic hip fracture-dislocation: A middle-term follow up study and a proposal of new classification system of hip joint associated injury. Injury. 2019;50(Suppl 4):S11–S20. doi: 10.1016/j.injury.2019.01.011. - DOI - PubMed

Publication types

MeSH terms