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Updated: Jun 16, 2026
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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Femoral head fractures systematic review and meta-analysis
Samuel C Marshall1,2, Jinpu Li2, Emily V Leary2
1Department of Orthopaedic Surgery, University of Oklahoma, Norman, United States.
Summary
Femoral head fractures remain high-energy injuries with a 35% adverse outcome rate. The Pipkin classification and open reduction internal fixation (ORIF) are common, but no link between fracture type, treatment, and outcomes was found.
Area of Science:
- Orthopedic surgery
- Trauma research
- Biomechanical engineering
Background:
- Femoral head fractures are infrequent but severe injuries.
- These fractures have a significant complication rate.
- Previous reviews highlight the need for updated literature analysis.
Purpose of the Study:
- To review femoral head fracture literature published since 2009.
- To identify changes in classification systems and management strategies.
- To determine trends in associated adverse outcomes.
Main Methods:
- Systematic literature search of PubMed from 2009 to 2025.
- Meta-analysis of pooled proportion of adverse outcomes.
- Random effects models used to address heterogeneity between studies.
Main Results:
- Twenty-two studies were included, predominantly detailing traffic accidents in middle-aged men.
- The Pipkin classification (86.4%) and open reduction internal fixation (ORIF) were most common.
- Adverse outcomes (heterotopic ossification, osteoarthritis, avascular necrosis) ranged from 9% to 37%.
Conclusions:
- The Pipkin classification and ORIF remain standard for femoral head fractures.
- Despite advances, the overall adverse outcome rate is high (35%).
- No clear correlation was found between fracture type, treatment, and patient outcomes.
