• Stephan Regenbogen, Julius Watrinet, Markus Beck, Philipp Osten, Fabian M Stuby, Paul Alfred Grützner, and Vera Jaecker.
• Department of Traumatology and General Surgery, BG Unfallklinik Murnau, Murnau am Staffelsee, Germany. s_regenbogen@web.de.
• Arch Orthop Trauma Surg. 2024 Sep 10.

IntroductionA femoral head fracture (Pipkin fracture) is a rare but severe injury. The optimal treatment is controversial, and there is a lack of research focusing on treatment strategies. The study aimed to analyze the treatment strategies in comparison to the outcome in patients after traumatic hip joint dislocation (THD) with concomitant femoral head fractures.Materials And MethodsA retrospective multicenter study at three Level I Trauma Centers was performed over a 12 year period from January 2009 to January 2021. Epidemiological data, associated injuries, and treatment were recorded. Patients were followed up for further treatment, re-operations, complications, and long-term functional outcomes using patient-reported outcome measures (PROMs), specifically the modified Harris Hip Score (mHHS) and the Tegner Activity Scale (TAS).Results45 patients with a mean age of 44 ± 16.11 years were finally evaluated. The majority of 38 patients (84%) were treated surgically. The mean follow-up time was 5.75 years (range 2-12 years). 8 patients (31%) developed post-traumatic osteoarthritis and 4 patients (15%) developed osteonecrosis of the femoral head. 7 patients (27%) underwent total hip arthroplasty (THA). Fixation of the Pipkin fracture was more common in younger patients but had no statistically significant impact on PROMs. Patients with a higher BMI were significantly less likely to undergo fragment fixation (p < 0.05). TAS was significantly worse in patients who underwent THA (p < 0.05).ConclusionsA femoral head fracture is a severe injury with overall limitations in activities of daily living and a high rate of post-traumatic osteoarthritis and osteonecrosis of the femoral head. Fragment fixation had no statistically significant impact on the outcome and PROMs. Treatment strategies should be guided by the fracture type, the patient's condition, and associated injuries. However, concomitant and life-threatening injuries may affect the treatment and limit the outcome.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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