How to perform surgical treatment for femoral head fracture?

The femoral head is the bone that connects the pelvis and thigh bone. This bone is very important to people because the health of the femoral head is crucial to people's ability to walk. Once femoral head necrosis occurs, the patient will experience symptoms of lower body paralysis, forcing the patient to rely on a wheelchair to walk for the rest of his life. Although femoral head fracture is not that serious, it can greatly affect the ability to walk. Femoral head fracture is treatable, and generally surgical treatment is more effective. Let’s take a look at how to perform surgical treatment for femoral head fracture.

(1) Incision: Make a lateral or posterolateral incision 10 to 12 cm long with the fracture as the center. Incise the skin and fascia lata to expose the vastus lateralis muscle.

(2) Exposure: Separate and pull the vastus lateralis muscle forward, enter the gap between it and the biceps femoris, or directly cut and separate the vastus lateralis muscle, but this will cause more bleeding. The periosteum was incised to expose the upper and lower ends of the femoral fracture. The exposure range should be sufficient for observation and reduction, and the soft tissue should be stripped as little as possible.

(3) Reduction and internal fixation: adduct the affected limb to expose the proximal stump, insert a plum blossom or V-shaped intramedullary nail, and test whether the thickness of the needle is appropriate. If there is a narrow area in the medullary cavity, a medullary cavity expander can be used to appropriately trim and expand it to avoid the needle being unable to be inserted or removed. Use a bone holder to fix the proximal end, and insert the intramedullary needle retrogradely, passing it through the greater trochanter of the femur. When the needle tip pushes up the skin, make a small 3 cm incision at that location, and continue to insert the intramedullary needle until it is exposed outside the skin. Pull out the intramedullary nail, change its direction, pass through the hole from the greater trochanter, and then drive it into the proximal fracture end to the fracture plane. Both ends of the improved intramedullary nail are made into small circles and are provided with needle extraction holes. There is no need to pull it out and change the direction, you can hit it out once and then hit it in again. Another method is to first use a guide needle to penetrate retrogradely, and after it is exposed outside the incision of the greater trochanter, the intramedullary needle is put on and inserted into the medullary cavity.

(4) To further reduce the fracture, the lever effect of the intramedullary nail at the proximal end can be used in combination with techniques such as bone prying, traction, and folding to achieve anatomical alignment. Fix it with a bone holder, then insert the intramedullary nail so that the needle extraction hole faces the posterior side to conform to the curvature of the femur. The needle tip must reach the appropriate position of the distal end, but cannot pass through the cartilage layer. The needle tail should be left 2 cm outside the tuberosity for later removal.

(5) After reduction and fixation, try passive movement of the limb to observe whether there is instability. If it is necessary to replace the intramedullary nail with a thicker one, it can be pulled out and replaced. If it is slightly loose or unstable, you can add another screw to reinforce it.

(6) Finally, rinse the wound and suture it in layers. Wear an anti-external rotation plaster boot.