Ann Surg Case Rep | Volume 7, Issue 1 | Research Article | Open Access

Femoral Head Fractures Systematic Review and Meta- Analysis

Marshall SC1, Li J1 2, Leary EV1,2 and Crist BD1,2*

1Department of Orthopedic Surgery, University of Missouri, USA
2Thompson Laboratory for Regenerative Orthopedics, University of Missouri, USA

*Correspondance to: Brett Crist 

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Objective: Femoral head fractures are rare, high-energy injuries with a relatively high complication rate. This study evaluated the femoral head fracture literature published since the most recent systematic review in 2009 and determined changes in: Classification systems, management of these injuries, and the associated adverse outcomes. Methods: A PubMed search from January 2009 to June 2021 was performed. Terms associated with femoral head fractures were entered. Meta-analysis was performed for the pooled proportion of patients who experienced adverse outcomes in the evaluated studies. Heterogeneity between studies was tested using the Q test and, if significant, random effect models were applied. Confidence intervals from individual studies and stabilized pooled proportions are reported. Results: Sixteen articles met inclusion criteria. Of these, 13 of the studies supplied the mechanism of injury as well as patient age and sex. The most common mechanism of injury was traffic accidents in all of the 13 studies with the majority of the injured middle-aged men. The Pipkin classification was used in 81.3% of studies. Open Reduction and Internal Fixation (ORIF) (81.3%), and fragment excision (50%) were the two most common surgical techniques used. Adverse outcomes for patients included heterotopic ossification, post-traumatic osteoarthritis, and Avascular Necrosis (AVN) with rates from 9% to 37%, across studies. For the rate of adverse outcomes, heterogeneity between studies was identified using a random effects model. Conclusion: Since 2009, the Pipkin classification system remains the most often used for femoral head fractures and ORIF is the most common treatment method. Although femoral head fractures are rare, the adverse outcome rate following injury is extremely high (37%). However, no relationships between fracture type, treatment type, and favorable outcome were identified.


Femoral head fractures; Systematic review; Meta-analysis; Adverse outcomes


Marshall SC, Li J, Leary EV, Crist BD. Femoral Head Fractures Systematic Review and Meta-Analysis. Ann Surg Case Rep. 2024; 7(1): 1085..

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