Femoral head fractures systematic review and meta-analysis

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 systematic review in 2009 and determined changes in: classification systems, management of these injuries, and the associated adverse outcomes.

A PubMed search from January 2009 to January 2025 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.

Twenty-two articles met inclusion criteria. All 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 the 22 studies with many of the injured middle-aged men. The Pipkin classification was used in 86.4% of studies. Open reduction and internal fixation (ORIF) and fragment excision were the two most common surgical techniques used. Adverse outcomes for patients included heterotopic ossification, post-traumatic osteoarthritis, and avascular necrosis with rates from 9 to 37%, across studies. For the rate of adverse outcomes, heterogeneity between studies was identified using a random effects model.

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 (35%). However, no relationships between fracture type, treatment type, and favorable outcome were identified.