Functional Outcome and Hip Survival Rate in Traumatic Femoral Head Fractures

Objective: Femoral head fractures are rare and severe injuries often associated with high-energy trauma. Early recognition and rapid, stable reduction are essential for successful treatment to prevent complications and morbidity. This retrospective study aims to describe and analyze long-term outcomes and survival rates of the femoral head after a Pipkin fracture. Methods: Between 2012 and 2021, all patients with a femoral head fracture who were treated in a Level I Trauma Center were assessed and analyzed. Two examiners performed a physical examination and radiological control of patients and called the patients for a final follow-up. Anterior and posterior fracture-dislocations and femoral head fractures were classified according to Pipkin's classification system. The functional outcome was assessed using the Harris Hip Score (HHS). Results: Over a 10-year period, n = 15 patients were diagnosed with a femoral head fracture. All patients were male; the average age at admission was 41.3 years. The mean follow-up was 43.7 months ± 46 months. No complications occurred in three patients (20%). Twelve patients had complications. The most common complications were nerve lesions and posttraumatic osteoarthritis. Regarding the outcome, no data were available for two patients; one patient died, and two of four patients remained with a Girdlestone resection arthroplasty at the follow-up. The mean score in HHS was 76.69 ± 20.3 (mean ± standard deviation). Conclusions: An overall complication rate of 80% was observed; however, functional outcomes were generally moderate at final follow-up. These findings highlight the considerable risk of complications associated with femoral head fractures, particularly nerve injury and posttraumatic osteoarthritis. Notably, six of 15 patients no longer retained their native hip joint at the time of assessment. The study is a Level 2b study.