Research Articles

Clinical and Radiographic Outcomes of Femoral Head Fractures: Insights from a Single-Center Retrospective Analysis

Abstract

Background: This study evaluates the radiologic and functional outcomes of femoral head fractures, focusing on the correlations between radiologic parameters and complications.

Methods: We conducted a retrospective analysis of 26 Pipkin fractures. Complications and outcomes were documented, with measurements taken for head-neck ratio, surface ratio in multiple planes, and head volume for further analysis.

Results: Associated injuries were observed in 65.38% of cases. Osteoarthritis developed in 61.53%, avascular necrosis of the femoral head in 50%, and heterotopic ossification in 26.92%. According to the Epstein scale, among the 26 patients, seven (26.92%) rated their outcomes as excellent, 11 (42.30%) as good, five (19.23%) as fair, and three (11.53%) as poor. Our findings indicate that head volume ratio, differences in head-neck ratio, and surface ratios in various planes correlate with late complications. Specifically, osteoarthritis was associated with the sagittal surface ratio (P=0.026) and coronal surface ratio (P=0.034) in Type II fractures, while in Type IV fractures, it correlated with the axial surface ratio (P=0.023), head volume (P=0.020), and differences in head-neck ratio (P=0.017). Heterotopic ossification was linked to head volume ratio (P=0.028) in Type II, and to coronal surface ratio (P=0.017) and differences in head-neck ratio (P<0.001) in Type IV. Avascular necrosis correlated with differences in head-neck ratio (P=0.041) in Type IV, and with head volume ratio (P=0.012) and sagittal surface ratio (P=0.012) in Type II.

Conclusion: In summary, head-neck ratio, head volume ratio, and surface ratios are predictive of late complications following femoral head fractures.

1. Ross JR, Gardner MJ. Femoral head fractures. Curr Rev Musculoskelet Med. 2012;5(3):199-205. doi: 10.1007/s12178-012- 9129-8. [PubMed: 22628176]. [PubMed Central: PMC3535084].
2. Giordano V, Giordano M, Glória RC, de Souza FS, di Tullio P, Lages MM, et al. General principles for treatment of femoral head fractures. J Clin Orthop Trauma. 2019;10(1):155-60. doi: 10.1016/j.jcot.2017.07.013. [PubMed: 30705552]. [PubMed Central: PMC6349681].
3. Alonso JE, Volgas DA, Giordano V, Stannard JP. A review of the treatment of hip dislocations associated with acetabular fractures. Clin Orthop Relat Res. 2000(377):32-43. doi: 10.1097/00003086-200008000-00007. [PubMed: 10943183].
4. Pipkin G. Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am. 1957;39-A(5):1027-42 passim. [PubMed: 13475403].
5. Droll KP, Broekhuyse H, O'Brien P. Fracture of the femoral head. J Am Acad Orthop Surg. 2007;15(12):716-27. doi: 10.5435/00124635-200712000-00005. [PubMed: 18063712].
6. Peng SH, Wu CC, Yu YH, Lee PC, Chou YC, Yeh WL. Surgical treatment of femoral head fractures. Biomed J. 2020;43(5): 451-7. doi: 10.1016/j.bj.2019.08.004. [PubMed: 33011107]. [PubMed Central: PMC7680813].
7. Lawand J, Loeffelholz Z, Khurshid B, Barcak E. Heterotopic Ossification after Trauma. Orthop Clin North Am. 2023;54(1): 37-46. doi: 10.1016/j.ocl.2022.08.007. [PubMed: 36402509].
8. Engel JL, Johnsen P, Patel NK, Satpathy J, Mounasamy V. Pipkin type IV femoral head fractures: a case series and review of literature. Eur J Orthop Surg Traumatol. 2021;31(4):791-5. doi: 10.1007/s00590-020-02838-5. [PubMed: 33211232].
9. Guimaraes RP, Saeki de Souza G, da Silva Reginaldo S, Ono NK, Honda EK, Polesello GC, et al. Study of the treatment of femoral head fractures. Rev Bras Ortop. 2010;45(4):355-61. doi: 10.1016/S2255-4971(15)30381-5. [PubMed: 27022564]. [PubMed Central: PMC4799121].
10. Khalifa AA, Haridy MA, Fergany A. Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis. World J Orthop. 2021;12(8):604-19. doi: 10.5312/wjo.v12.i8.604. [PubMed: 34485106]. [PubMed Central: PMC8384609].
11. Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop Relat Res. 1985(201):9-17. [PubMed: 4064426].
12. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83(8):1119-24. doi: 10.1302/0301-620x.83b8.11964. [PubMed: 11764423].
13. Zandi R, Talebi S, Ehsani A, Nodehi S. Two-step sequential management for hip arthroplasty after hip joint gunshot injury: A case report. Clin Case Rep. 2023;11(6):e7569. doi: 10.1002/ccr3.7569. [PubMed: 37334340]. [PubMed: PMC10276239].
14. Kellgren JH, Lawrence JS. Radiological assessment of osteo- arthrosis. Ann Rheum Dis. 1957;16(4):494-502. doi: 10.1136/ard.16.4.494. [PubMed: 13498604]. [PubMed: PMC1006995].
15. Steinberg ME, Hayken GD, Steinberg DR. A quantitative systemfor staging avascular necrosis. J Bone Joint Surg Br. 1995;77(1):34-41. [PubMed: 7822393].
16. Brooker AF, Bowerman JW, Robinson RA, Riley LH, Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55(8): 1629-32. [PubMed: 4217797].
17. Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C. Articular step-off and risk of post- traumatic osteoarthritis. Evidence today. Injury. 2010;41(10): 986-95. doi: 10.1016/j.injury.2010.08.003. [PubMed: 20728882].
18. Park KS, Lee KB, Na BR, Yoon TR. Clinical and radiographic outcomes of femoral head fractures: excision vs. fixation of fragment in Pipkin type I: what is the optimal choice for femoral head fracture? J Orthop Sci. 2015;20(4):702-7. doi: 10.1007/s00776-015-0732-6. [PubMed: 25952457].
19. Del Core MA, Gross B, Ahn J, Wallace SB, Starr A. Clinical and Radiographic Outcomes of Femoral Head Fractures Associated with Traumatic Hip Dislocations. Strategies Trauma Limb Reconstr. 2019;14(1):6-10. doi: 10.5005/jp-journals-10080-1416. [PubMed: 32559260]. [PubMed: PMC7001600].
20. Hosny H, Mousa S, Salama W. Management of femoral head fracture by Ganz surgical dislocation of the hip. J Orthop Traumatol. 2022;23(1):24. doi:10.1186/s10195-022-00643-w. [PubMed: 35538323]. [PubMed: PMC9091069].
21. Scolaro JA, Marecek G, Firoozabadi R, Krieg JC, Routt MLC. Management and radiographic outcomes of femoral head fractures. J Orthop Traumatol. 2017;18(3):235-41. doi: 10.1007/s10195- 017-0445-z. [PubMed: 28188487]. [PubMed: PMC5585088].
22. Halle B, Halle DM, Torfing T, Overgaard S. The role of acetabulum geometry and femoral head-neck ratio in the development of osteoarthritis in young men. Hip Int. 2007;17(3):131-6. doi: 10.1177/112070000701700302. [PubMed: 19197857].
23. Menger MM, Braun BJ, Herath SC, Küper MA, Rollmann MF, Histing T. Fractures of the femoral head: a narrative review. EFORT Open Rev. 2021;6(11):1122-31. doi: 10.1302/2058-5241.6.210034. [PubMed: 34909230]. [PubMed Central: PMC8631236].
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IssueVol 11 No 1 (2025) QRcode
SectionResearch Articles
DOI https://doi.org/10.18502/jost.v11i1.18010
Keywords
Heterotopic Ossification Proximal Femoral Fractures Femur Head Necrosis Open Fracture Reduction Total Hip Arthroplasty
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How to Cite
1.
Zandi R, Keyhaninejad N, Talebi S, Nodehi S, Ehsani A. Clinical and Radiographic Outcomes of Femoral Head Fractures: Insights from a Single-Center Retrospective Analysis. J Orthop Spine Trauma. 2025;11(1):27-31.