Management of Femoral Head Fractures: A Systematic Review

Femoral head fractures, though rare, represent a significant challenge in orthopaedic practice due to their anatomical complexity, association with high-energy trauma, and potential for severe complications. These fractures often result from mechanisms such as motor vehicle accidents or falls from heights and are frequently accompanied by posterior hip dislocations. The primary aim of this systematic review was to evaluate the effectiveness of various management strategies for femoral head fractures, identify factors influencing outcomes, and highlight gaps in the current literature. This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of databases, including PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, identified 16 studies involving 1,234 patients. Data extraction focused on fracture classification, treatment approaches, functional outcomes, complications, and long-term prognosis. The findings emphasised that non-operative management is effective only in select cases of minimally displaced fractures. Open reduction and internal fixation emerged as the gold standard for displaced fractures, with superior functional outcomes when anatomical reduction is achieved. Emerging techniques, such as surgical hip dislocation and hip arthroscopy, have shown promise as alternatives in specific scenarios, offering improved exposure or minimally invasive options. However, complications such as avascular necrosis and post-traumatic arthritis remain prevalent, particularly in cases with delayed intervention or suboptimal surgical outcomes. The review concludes that individualised, evidence-based approaches are essential for optimising treatment outcomes. Future research should focus on high-quality randomised controlled trials, the development of standardised outcome measures, and long-term studies to evaluate the durability of interventions. Innovations such as minimally invasive techniques warrant further exploration to improve patient care and recovery.