Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 May 31;55(Suppl 2):304-313.
doi: 10.1007/s43465-021-00431-4. eCollection 2021 Jul.

Articular Femoral Head Fracture Management: A Meta-analysis of Literature

Giulia Bettinelli  1 , Giacomo Placella  2 , Désirée Moharamzadeh  2 , Alberto Belluati  3 , Vincenzo Salini  1   2
Affiliations
Review

Articular Femoral Head Fracture Management: A Meta-analysis of Literature

Giulia Bettinelli et al. Indian J Orthop. .

Abstract

Purpose: Articular fractures of the proximal femur are seldom encountered and there are few studies in literature regarding this topic. To date, only a few large series have adequate follow-up and exhaustive description of treatment and outcome, which, however, often result incomplete and do not allow a comparison. Since there are still uncertainties and debates on which the treatment gold standard should be, the goal of the present study is to carry out a meta-analysis on type I and II Pipkin fracture management to establish the best treatment according to EBM.

Methods: Studies regarding acetabular fractures of the femur head were identified from Google Scholar, Cochrane Library, Medline, ScienceDirect and PubMed; gray studies were searched from the included references' literature, and using general search engines and Social media; the query to be temporally extended from 1996 to 2020. Only comparative studies were included; we ruled out case-reports, case series, author's opinion, register databases.

Results: Comparing conservative and surgical treatment, we found evidence of a better outcome choosing surgical treatment. We found a significant better outcome with open reduction internal fixation, instead of fragment excision. Comparing failure rate of surgical approaches, we found no statistically significant difference.

Conclusion: Our study proves that there is evidence in favor of operative treatment rather than conservative in complete or displaced Pipkin fracture Type I + II; open reduction internal fixation should be preferred rather than fragment excision, whenever possible.

Level of evidence: III. Therapeutic.

Keywords: Femoral head fracture; Hip dislocation; Hip fracture; Pipkin.

PubMed Disclaimer

Conflict of interest statement

Conflict of interestThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart showing article selection process
Fig. 2
Fig. 2
Funnel plot referred to studies included; no significant heterogeneity was found
Fig. 3
Fig. 3
Forest plot demonstrating a significant difference between surgical or conservative management, in favor of surgical treatment
Fig. 4
Fig. 4
HO formation risk: no significant result was obtained comparing surgical vs conservative treatment
Fig. 5
Fig. 5
In terms of AVN, no significant result was obtained comparing conservative and surgical treatment
Fig. 6
Fig. 6
Forest plot showing significant better outcome we gained when comparing ORIF vs excision, in favor of ORIF
See this image and copyright information in PMC

References

    1. Uzel AP, Laflamme GY, Rouvillain JL. Irreducible Pipkin II femoral head fractures: Is transgluteal approach the best strategy? Orthopaedics Traumatology: Surgery & Research. 2010;96(6):695–701. - PubMed
    1. Wang J, Cai L, Xie L, Chen H, Guo X, Yu K. 3D printing-based Ganz approach for treatment of femoral head fractures: A prospective analysis. Journal of Orthopaedic Surgery and Research. 2019;14(1):1–11. doi: 10.1186/s13018-015-0338-x. - DOI - PMC - PubMed
    1. Maniglio M, Bäcker H, Fornaciari P, Wahl P, Gautier E. Obturator dislocation of the hip with associated femoral head impaction and medial wall fracture of the acetabulum. Journal of Orthopaedic Case Reports. 2019;9(1):65. - PMC - PubMed
    1. Bartoníček J, Rammelt S. History of femoral head fracture and coronal fracture of the femoral condyles. International Orthopaedics. 2015;39(6):1245–1250. doi: 10.1007/s00264-015-2730-x. - DOI - PubMed
    1. Kapandji IA. The physiology of the joints. Churchill Livingstone; 2007.

LinkOut - more resources