This is a 13-year single-institution retrospective series of 147 femoral head fractures (AO/OTA 31C). It evaluates surgical approach, fixation method, and radiographic outcomes including union, AVN, and heterotopic ossification. It represents one of the largest consecutive series and the largest ORIF cohort reported.
When you see a displaced combined femoral neck and head fracture (Pipkin III), lean toward arthroplasty rather than fixation. Every Pipkin III in this series failed, either by catastrophic loss of fixation or AVN.
The surgical approach choice teaches a core vascular principle. The anterior Smith-Petersen preserves the posterior-based medial femoral circumflex supply, and this series reported AVN of only 8.7% versus historic rates near 25% with posterior approaches.
The tradeoff is heterotopic ossification, which occurred in 40.6% of cases with the anterior approach. Reassure yourself and the patient that most is low-grade Brooker I, non-bridging, and rarely needs excision.
For fixation itself, small 2.0 to 2.4 mm countersunk lag screws are enough because the reduced acetabulum splints the fragment. This is Level IV prognostic evidence with under 50% follow-up, so weight it as guidance, not a mandate.
This is a 13-year single-institution retrospective series of 147 femoral head fractures (AO/OTA 31C). It evaluates surgical approach, fixation method, and radiographic outcomes including union, AVN, and heterotopic ossification. It represents one of the largest consecutive series and the largest ORIF cohort reported.
When you see a displaced combined femoral neck and head fracture (Pipkin III), lean toward arthroplasty rather than fixation. Every Pipkin III in this series failed, either by catastrophic loss of fixation or AVN.
The surgical approach choice teaches a core vascular principle. The anterior Smith-Petersen preserves the posterior-based medial femoral circumflex supply, and this series reported AVN of only 8.7% versus historic rates near 25% with posterior approaches.
The tradeoff is heterotopic ossification, which occurred in 40.6% of cases with the anterior approach. Reassure yourself and the patient that most is low-grade Brooker I, non-bridging, and rarely needs excision.
For fixation itself, small 2.0 to 2.4 mm countersunk lag screws are enough because the reduced acetabulum splints the fragment. This is Level IV prognostic evidence with under 50% follow-up, so weight it as guidance, not a mandate.