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

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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.

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Authors and Affiliations

  1. Università Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy

    Giulia Bettinelli & Vincenzo Salini

  2. IRCSS Ospedale San Raffaele, Milan, Italy

    Giacomo Placella, Désirée Moharamzadeh & Vincenzo Salini

  3. Ospedale Santa Maria delle Croci, Ravenna, Italy

    Alberto Belluati

Authors
  1. Giulia Bettinelli
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  2. Giacomo Placella
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  3. Désirée Moharamzadeh
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  5. Vincenzo Salini
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Correspondence to Giulia Bettinelli.

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Bettinelli, G., Placella, G., Moharamzadeh, D. et al. Articular Femoral Head Fracture Management: A Meta-analysis of Literature. JOIO 55 (Suppl 2), 304–313 (2021). https://doi.org/10.1007/s43465-021-00431-4

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  • DOI: https://doi.org/10.1007/s43465-021-00431-4

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