Clinical and Radiographic Outcomes of Femoral Head Fractures: Insights from a Single-Center Retrospective Analysis

Background: This study evaluates the radiologic and functional outcomes of femoral head fractures (FHFs), focusing on the correlations between radiologic parameters and postoperative complications. Methods: We conducted a retrospective analysis of 26 Pipkin fractures. Complications and outcomes were documented, with measurements taken for head-neck ratio, surface ratio in multiple planes, and head volume for further analysis. Results: Associated injuries were observed in 65.38% of cases. Osteoarthritis (OA) developed in 61.53%, avascular necrosis (AVN) of the femoral head in 50%, and heterotopic ossification (HO) in 26.92%. According to the Epstein scale, among the 26 patients, seven (26.92%) rated their outcomes as excellent, 11 (42.30%) as good, five (19.23%) as fair, and three (11.53%) as poor. Our findings indicated that head volume ratio, differences in head-neck ratio, and surface ratios in various planes correlated with late complications. Specifically, OA was associated with the sagittal surface ratio (P = 0.026) and coronal surface ratio (P = 0.034) in type II fractures, while in type IV fractures, it correlated with the axial surface ratio (P = 0.023), head volume (P = 0.020), and differences in head-neck ratio (P = 0.017). HO was linked to head volume ratio (P = 0.028) in type II, and to coronal surface ratio (P = 0.017) and differences in head-neck ratio (P < 0.001) in type IV fractures. AVN correlated with differences in head-neck ratio (P = 0.041) in type IV, and with head volume ratio (P = 0.012) and sagittal surface ratio (P = 0.012) in type II fractures. Conclusion: Head-neck ratio, head volume ratio, and surface ratios are predictive of late complications following FHFs.