Surgical Approaches for Managing Femoral Head Fractures (FHFs); What and How to Choose from the Different Options?

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Abstract

Conflict of interest statement: The authors report no conflicts of interest in this work. 20. J Orthop Surg Res. 2025 Nov 24;20(1):1029. doi: 10.1186/s13018-025-06442-3. Femoral head fracture management: outcomes of surgical hip dislocation with bioabsorbable screw fixation. Chen J(1)(2), Zhang Y(3), Feng Z(1)(2), Cai L(1)(2), Huang S(1)(2), Liu Z(4), Liu W(5)(6). Author information: (1)The Eighth Clinical Medical School of Guangzhou University of Chinese Medicine, Foshan, 528000, China. (2)Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, China. (3)Jiangxi University of Chinese Medicine, Nanchang, 330004, Jiangxi, China. (4)Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, China. (5)The Eighth Clinical Medical School of Guangzhou University of Chinese Medicine, Foshan, 528000, China. 1587122711@qq.com. (6)Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, China. 1587122711@qq.com. PURPOSE: Pipkin fractures are rare, complex hip injuries typically caused by high-energy trauma. Surgical management must balance adequate exposure with preservation of femoral head vascularity. We evaluated outcomes of surgical hip dislocation with absorbable screw fixation for Pipkin fractures. METHODS: We retrospectively reviewed 10 patients with Pipkin fractures treated by surgical hip dislocation and absorbable screw fixation at Foshan Traditional Chinese Medicine Hospital from December 2018 to March 2023. Demographics, Pipkin classification, and injured limb were recorded. All patients had at least 2 years of follow-up. Outcomes included fracture healing time, Modified Harris Hip Score (MHHS), and modified Merle d'Aubigné score. Complications, including avascular necrosis (AVN) and post-traumatic osteoarthritis (PTOA), were documented. RESULTS: At final follow-up, the mean MHHS was 90.3 ± 6.8. Functional results were excellent in 7 patients, good in 2, and fair in 1 (excellent-to-good rate, 90%). Modified Merle d'Aubigné scores paralleled the MHHS. One patient with a Pipkin type III fracture developed AVN; no other major complications were observed. Patients with Pipkin types I and II achieved better functional recovery than those with types III and IV. CONCLUSIONS: In treating Pipkin fractures, surgical hip dislocation provides adequate exposure while preserving femoral head vascularity. Bioabsorbable screws achieve stable fixation through their thread design and axial compression, supporting fracture healing. This technique shows promise as a treatment strategy for complex femoral head fractures. © 2025. The Author(s). DOI: 10.1186/s13018-025-06442-3 PMCID: PMC12642180