Features of the femoral head fractures treatment

Mykola Ankin, Taras Petryk, Viktoriia Ladyka, Sergii Dudar


In recent decades, the number of femoral head fractures (FHF) has been slowly increasing, which are due to an increase in the incidence of road traffic accidents and survival after high-energy injuries.

Objective: to analyze the results of surgical and conservative treatment of the FHF and to prove treatment tactics of this injury.

Methods: a retrospective analysis of the results of treatment of patients with the FHF from 2002 to 2017 was carried out. Before the operation X-ray and CT examinations of pelvic bones were made. Fractures were distributed according to the classification Pipkin: type I — 10 (25,6 %) patients, II — 7 (17.9 %), III — 1 (2.6 %), IV — 21 (53.8 %). Conservative treatment after elimination of dislocation was performed in 8 (20.5 %) patients: type Pipkin I — 6 (15.4 %); Pipkin II — 2 (5.1 %). Results: there were such complications as: heterotopic ossification in 1 (3.0 %) patients, aseptic necrosis of the femoral head — 7 (23.3 %), (2 — with fractures Pipkin II, 5 — Pipkin IV). In the period from 12 to 36 months after the injury, 32 (76.9 %) patients had got results of treatment according to the Thompson-Epstein scale: excellent — 9 (28.1 %), good — 10 (31.3 %), satisfactory — 5 (15.6 %), unsatisfactory — 8 (25.0 %).

Conclusions: in the case of type-fractures of Pipkin I and II, better functional results were obtained compared with the more severe type of Pipkin IV fracture. Late open reduction of displaced fractures resulted in the development of aseptic femoral head necrosis in 66.7 % of cases. The choice of the method of treatment of the FHF depends on the type of fracture. In the case of fractures like Pipkin I conservative treatment has led to a high percentage of good results. Under conditions of Pipkin II type fractures, the best indexes were observed after open reduction and osteosynthesis of fragments, Pipkin III — hip joint replacement, Pipkin IV — osteosynthesis of acetabulum and FHF.


fracture of the femoral head; fracture head dislocation; hip joint; aseptic necrosis; osteosynthesis


Hougaard, K., & Thomsen, P. B. (1988). Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both. The Journal of Bone & Joint Surgery, 70 (2), 233–239. doi: 10.2106/00004623-198870020-00011

Roeder, L. F., & Delee, J. C. (1980). Femoral head fractures associated with posterior hip dislocations. Clinical Orthopaedics and Related Research, (147), 121–130. doi: 10.1097/00003086-198003000-00018

Lang-Stevenson, A., & Getty, C. (1987). The Pipkin fracture-dislocation of the hip. Injury, 18 (4), 264–269. doi:10.1016/0020-1383(87)90011-8

Epstein, H. C., Wiss, D. A., & Cozen, L. (1985). Posterior fracture dislocation of the hip with fractures of the femoral head. Clinical Orthopaedics and Related Research, (201), 9–17. doi: 10.1097/00003086-198512000-00002

Sahin, V, Karaka, E. S., Aksu, S., Atlihan, D., Turk, C. Y., & Halici, M. (2003). Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. The Journal of Trauma: Injury, Infection, and Critical Care, 54 (3), 520–529. doi: 10.1097/01.ta.0000020394.32496.52

Droll, K. P., Broekhuyse, H., & O'brien, P. (2007). Fracture of the femoral head. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 15 (12), 716–727.

Pipkin, G. (1957). Treatment of Grade IV fracture-dislocation of the hip. The Journal of Bone & Joint Surgery, 39 (5), 1027–1197. doi:10.2106/00004623-195739050-00004

Ankin, L. N., & Ankin, N. L. (2018). Traumatology. European standards for diagnosis and treatment. Moscow: Book Plus. (in Russian)

Rosenthal, R. E., & Coker, W. L. (1979). posterior fracture-dislocation of the hip. The Journal of Trauma: Injury, Infection, and Critical Care, 19 (8), 572–581. doi:10.1097/00005373-197908000-00005

Epstein, H. C. (1974). Posterior fracture-dislocations of the hip. The Journal of Bone & Joint Surgery. American volume, 56 (6), 1103–1127. doi:10.2106/00004623-197456060-00001

Rüedi, T. P., & Murphy, W. M. (2000). AO Principles of Fracture Management. Stuttgart, Germany: Thieme.

Yu, X., Pang, Q., & Chen, X. (2017). Clinical results of femoral head fracture-dislocation treated according to the Pipkin classification. Pakistan Journal of Medical Sciences, 33 (3). doi: 10.12669/pjms.333.12633

Gavaskar, A. S., & Tummala, N. C. (2015). Ganz surgical dislocation of the hip is a safe technique for operative treatment of Pipkin fractures. Results of a Prospective Trial. Journal of Orthopaedic Trauma, 29 (12), 544–548. doi: 10.1097/bot.0000000000000399

Kazantsev, A. B., Ter-Grigoryan, A. A., Putiatin, S. M., & Makarova, S. I. (2011). Surgical treatment of femoral head fractures. Journal of Experimental and Clinical Surgery, IV, 2, 375–377. (in Russian)

Solberg, B. D., Moon, C. N., & Franco, D. P. (2008). Use of a trochanteric flip osteotomy improves outcomes in Pipkin IV fractures. Clinical Orthopaedics and Related Research, 467 (4), 929–933. doi: 10.1007/s11999-008-0505-z

DeLee, J. C., Evans, J. A., & Thomas, J. (1980). Anterior dislocation of the hip and associated femoral-head fractures. The Journal of Bone & Joint Surgery. American volume, 62 (6), 960–964. doi:10.2106/00004623-198062060-00012

Giannoudis, P., Kontakis, G., Christoforakis, Z., Akula, M., Tosounidis, T., & Koutras, C. (2009). Management, complications and clinical results of femoral head fractures. Injury, 40 (12), 1245–1251. doi: 10.1016/j.injury.2009.10.024

Stannard, J. P., Harris, H. W., Volgas, D. A., & Alonso, J. E. (2000). Functional outcome of patients with femoral head fractures associated with hip dislocations. Clinical Orthopaedics and Related Research, (377), 44–56. doi: 10.1097/00003086-200008000-00008

Yoon, T. R., Rowe, S. M., Chung, J. Y., Song, E. K., Jung, S. T., & Anwar, I. B. (2001). Clinical and radiographic outcome of femoral head fractures: 30 patients followed for 3-10 years. Acta Orthopaedica Scandinavica, 72 (4), 348–353. doi: 10.1080/000164701753541998

Marchetti, M. E., Steinberg, G. G., & Coumas, J. M. (1996). Intermediate-term experience of Pipkin fracture-dislocations of the hip. Journal of Orthopaedic Trauma, 10 (7), 455–461. doi:10.1097/00005131-199610000-00002

Thompson, V. P., & Epstein, H. C. (1951). Traumatic dislocation of the hip. The Journal of Bone & Joint Surgery, 33 (3), 746–792. doi: 10.2106/00004623-195133030-00023

Polyushkin, K. S. & Shevchenko, A. V. (2015). Surgical aspects of the treatment of femoral head fractures (Pipkin). Kuban Scientific Medical Journal, 6 (155), 107–110. (in Russian)

Wang, S., Li, B., Li, J., Huang, F., Xiang, Z., Zhong, G., & Liu, L. (2018). Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws. Chinese Journal of Traumatology, 21 (3), 170–175. doi:10.1016/j.cjtee.2017.12.004

Copyright (c) 2019 Mykola Ankin, Taras Petryk, Viktoriia Ladyka, Sergii Dudar

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.