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

Reza Zandi; Nima Keyhaninejad; Shahin Talebi; Saeed Nodehi; Akbar Ehsani

doi:10.18502/jost.v11i1.18010

Reza Zandi Associate Professor, Department of Orthopedic Surgery, School of Medicine, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Nima Keyhaninejad Assistant Professor, Department of Orthopedics, School of Medicine, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Shahin Talebi Assistant Professor, Department of Orthopedics, School of Medicine, Taleghani Hospital Research Development Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Saeed Nodehi Resident, Department of Orthopedics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Akbar Ehsani Orthopedic Surgeon, Department of Orthopedics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v11i1.18010

Keywords: Heterotopic Ossification; Proximal Femoral Fractures; Femur Head Necrosis; Open Fracture Reduction; Total Hip Arthroplasty

Abstract

Background: This study evaluates the radiologic and functional outcomes of femoral head fractures (FHFs), focusing on the correlations between radiologic parameters and postoperative 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 (OA) developed in 61.53%, avascular necrosis (AVN) of the femoral head in 50%, and heterotopic ossification (HO) 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 indicated that head volume ratio, differences in head-neck ratio, and surface ratios in various planes correlated with late complications. Specifically, OA 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). HO 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 fractures. AVN 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 fractures.

Conclusion: Head-neck ratio, head volume ratio, and surface ratios are predictive of late complications following FHFs.