Outcomes of Surgical Treatment of Femoral Head Fractures with a Minimum of 1-Year Follow-up.

Background: Femoral head fractures are uncommon injuries, usually resulting from high-energy trauma and often accompanied by other musculoskeletal injuries, which complicate management. Despite advancements in surgical techniques, complications such as posttraumatic osteoarthritis (OA) and heterotopic ossification (HO) remain prevalent, and no standardized treatment protocol has been established. Furthermore, most existing reports are small-scale or multi-center studies with heterogeneous management. The aim of this study was to evaluate the radiological and functional outcomes, as well as complications, of surgically treated femoral head fractures managed by a single surgeon at a single center with a minimum of 1-year follow-up. Methods: This retrospective study included 48 patients who underwent surgery for femoral head fractures between January 2007 and December 2023. Demographic characteristics, injury mechanisms, associated injuries, surgical methods, conversion to total hip arthroplasty, and complications were obtained from medical records. Fractures were classified using the Pipkin system based on preoperative radiographs and 3-dimensional computed tomography. Postoperative evaluations included radiological assessment for OA, avascular necrosis, and HO, and functional assessments using the modified Postel-Merle d'Aubigné score and Thompson and Epstein clinical criteria. Final outcomes were analyzed according to Pipkin fracture type and surgical approach. Results: The rate of excellent or good outcomes was higher in Pipkin types I and II than in type IV according to both the Thompson-Epstein roentgenographic (100%, 100%, and 58.3%) and clinical (90%, 90.9%, and 54.2%) criteria. Merle d'Aubigné-Postel scores were also higher in Pipkin types I (16.4) and II (16.8) than in type IV (15.0). Posttraumatic OA was most frequent in the flip osteotomy group (75%) and in Pipkin type IV fractures (60%). HO occurred most commonly with the anterior and flip osteotomy approaches (33.3%) and in Pipkin type I fractures (40.0%). Conclusions: Femoral head fractures remain uncommon injuries often associated with concomitant trauma and a high incidence of complications. We demonstrated favorable radiological and functional outcomes following surgical treatment, with results analyzed according to Pipkin type and surgical approach. These findings offer clinically meaningful insights that may advance ongoing research on femoral head fractures.