Combined fractures of the femoral head and neck are uncommon and associated with dislocations of the hip. They should be suspected. Good quality imaging is essential for diagnosis.
Because these fractures involve the femoral head and neck, the blood supply to the fracture fragments is almost always disrupted. Because of the serious implications of these fractures the treatment has to be individualized. Because of the surgical technical difficulties in dealing with these fractures they demand a surgeon with special expertise in pelvic and acetabular trauma.
X-ray taken from Orozco R et al, (1998) Atlas of Internal Fixation. Used with kind permission.
Vascularization through ligamentum teres
The ligamentum teres arises from the transverse acetabular ligament and the posterior inferior portion of the acetabular fossa and attaches to the femoral head at the fovea capitis. Lesions of the ligamentum teres may be caused by dislocation or subluxation of the hip as well as acetabular fractures. However, rupture may occur simply from a twisting injury in the absence of major trauma.