Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 11 1 2025 03 02 27 31 Reza Zandi Associate professor of Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Nima Keyhaninejad assistant professor, Department of Orthopedics, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Shahin Talebi assistant professor, Department of Orthopedics, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saeed Nodehi Resident, Shahid Beheshti university of medical science, Tehran, Iran Akbar Ehsani Orthopedic Surgeon, Shaheed Beheshti university of medical science, Tehran, Iran 2024 08 31 2025 02 24 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. https://jost.tums.ac.ir/index.php/jost/article/view/622 https://jost.tums.ac.ir/index.php/jost/article/download/622/401