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.
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. Journal of Clinical Orthopaedics and Trauma. 2019;10(1): 155–160. https://doi.org/10.1016/j.jcot.2017.07.013.
3. Alonso JE, Volgas DA, Giordano V, Stannard JP. A review of the treatment of hip dislocations associated with acetabular fractures. Clinical Orthopaedics and Related Research. 2000;(377): 32–43. https://doi.org/10.1097/00003086-200008000-00007.
4. Pipkin G. Treatment of grade IV fracture-dislocation of the hip. The Journal of Bone and Joint Surgery. American Volume. 1957;39-A(5): 1027-1042 passim.
5. Droll KP, Broekhuyse H, O’Brien P. Fracture of the femoral head. The Journal of the American Academy of Orthopaedic Surgeons. 2007;15(12): 716–727. https://doi.org/10.5435/00124635-200712000-00005.
6. Peng SH, Wu CC, Yu YH, Lee PC, Chou YC, Yeh WL. Surgical treatment of femoral head fractures. Biomedical Journal. 2020;43(5): 451–457. https://doi.org/10.1016/j.bj.2019.08.004.
7. Lawand J, Loeffelholz Z, Khurshid B, Barcak E. Heterotopic Ossification after Trauma. The Orthopedic Clinics of North America. 2023;54(1): 37–46. https://doi.org/10.1016/j.ocl.2022.08.007.
8. Engel JL, Johnsen P, Patel NK, Satpathy J, Mounasamy V. Pipkin type IV femoral head fractures: a case series and review of literature. European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie. 2021;31(4): 791–795. https://doi.org/10.1007/s00590-020-02838-5.
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. Revista Brasileira De Ortopedia. 2010;45(4): 355–361. https://doi.org/10.1016/S2255-4971(15)30381-5.
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 Journal of Orthopedics. 2021;12(8): 604–619. https://doi.org/10.5312/wjo.v12.i8.604.
11. Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clinical orthopaedics and related research. 1985;(201): 9–17.
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. The Journal of Bone and Joint Surgery. British Volume. 2001;83(8): 1119–1124. https://doi.org/10.1302/0301-620x.83b8.11964.
13. Zandi R, Talebi S, Ehsani A, Nodehi S. Two-step sequential management for hip arthroplasty after hip joint gunshot injury: A case report. Clinical Case Reports. 2023;11(6): e7569. https://doi.org/10.1002/ccr3.7569.
14. KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Annals of the rheumatic diseases. 1957;16(4): 494–502. https://doi.org/10.1136/ard.16.4.494.
15. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. The Journal of bone and joint surgery British volume. 1995;77(1): 34–41.
16. Brooker AF, Bowerman JW, Robinson RA, Riley LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. The Journal of bone and joint surgery American volume. 1973;55(8): 1629–1632.
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): 986–995.
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? Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association. 2015;20(4): 702–707. https://doi.org/10.1007/s00776-015-0732-6.
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 in Trauma and Limb Reconstruction. 2019;14(1): 6–10. https://doi.org/10.5005/jp-journals-10080-1416.
20. Hosny H, Mousa S, Salama W. Management of femoral head fracture by Ganz surgical dislocation of the hip. Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology. 2022;23(1): 24. https://doi.org/10.1186/s10195-022-00643-w.
21. Scolaro JA, Marecek G, Firoozabadi R, Krieg JC, Routt MLC. Management and radiographic outcomes of femoral head fractures. Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology. 2017;18(3): 235–241. https://doi.org/10.1007/s10195-017-0445-z.
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 International: The Journal of Clinical and Experimental Research on Hip Pathology and Therapy. 2007;17(3): 131–136. https://doi.org/10.1177/112070000701700302.
23. Menger MM, Braun BJ, Herath SC, Küper MA, Rollmann MF, Histing T. Fractures of the femoral head: a narrative review. EFORT Open Reviews. 2021;6(11): 1122–1131. https://doi.org/10.1302/2058-5241.6.210034.
| Files | ||
| Issue | Vol 11 No 1 (2025) | |
| Section | Research Articles | |
| Keywords | ||
| femoral head fracture heterotopic ossification avascular necrosis post-traumatic arthritis surgical hip dislocation | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
