Rotational osteoplasty for femoral head fracture with cartilage loss.

Femoral head fractures often result in damage to the articular cartilage. This article describes a patient who sustained a femoral head fracture-dislocation with significant damage to the articular cartilage of the weight-bearing portion of his femoral head (A). After anatomic reduction of the fracture, a 2×4-cm osteochondral articular defect existed at the weight-bearing portion of the femoral head (B). The femoral head fragment was rotated such that the superior weight-bearing surface was congruent (C). This created a small gap at the inferior aspect of the femoral head, which was filled using a small corticocancellous graft harvested from the greater trochanter. The femoral head fragment was fixed with countersunk 3.5-mm screws. At 18-month follow-up, the patient had returned to full-time construction work with no limitations. He reported no pain in his hip or any activity limitations, and his Harris Hip Score was 91 points. Radiographs obtained 18 months postoperatively showed healing of the femoral head and preservation of the hip joint.