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.