Almost all are associated with hip dislocations.

These fractures complicate approximately 10% of posterior hip dislocations.

Most are shear or cleavage type. Although, with the increased use of computed tomography (CT), more indentation-type or crush-type fractures have been recognized.

Impaction fractures are more commonly associated with anterior hip dislocations (25% to 75%).

Vascular anatomy (see Chapter 27).

Seventy percent of the femoral head articular surface is involved in load transfer and, therefore, damage to this surface may lead to the development of posttraumatic arthritis.

Same as hip dislocation (see Chapter 27).

Formal trauma evaluation is necessary because most femoral head fractures are a result of high-energy trauma.

Ninety-five percent of patients have injuries that require inpatient management independent of femoral head fracture.

In addition to hip dislocation, femoral head fractures are also associated with acetabular fractures, knee ligament injuries, patella fractures, and femoral shaft fractures.

A careful neurovascular examination is essential because posterior hip dislocations may result in neurovascular compromise.

Same as hip dislocation (see Chapter 27).

If closed reduction is successful, CT is necessary to evaluate the reduction of the femoral head fracture and to rule out the presence of intra-articular fragments that may prevent hip joint congruity.