{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:39:49Z","timestamp":1786981189746,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Femoral head fractures are rare injuries with or without traumatic dislocations. The management of these fractures is crucial to prevent the development of severe complications and to achieve optimal functional outcomes. Wide treatment options for Pipkin 1 femoral head fractures range from fragment excision, fixation following open reduction with internal fixation, or conservative treatment such as close reduction alone after fracture dislocation. However, the best decision making remains controversial not only due to lack of large trials, but also inconsistent results reported. Therefore, we aim to compare the operative with nonoperative outcomes of Pipkin type 1 patients. Patients and Methods: We systemically searched MEDLINE, EMBASE, Cochrane library, In-Process &amp; Other Non-Indexed Citations to identify studies assessing outcomes of Pipkin type 1 patients after conservative treatment, and open reduction with excision or fixation. Data on comparison of clinical outcomes of each management were extracted including arthritis, heterotopic ossification (HO), avascular necrosis (AVN), and functional scores (Thompson Epstein, Merle\u2019 d Augine and Postel Score). We performed a meta-analysis with the available data. Results: Eight studies (7 case series and 1 RCT) were included in this study. In a pooled analysis, the overall rate of arthritis was 37% (95% CI, 2\u201379%), HO was 20% (95% CI, 2\u201345%), and AVN was 3% (95% CI, 0\u201316%). In comparison of management types, the excision group reached the best functional outcomes including Thompson Epstein Score (poor to worse, 9%; 95% CI, 0\u201327%) and Merle d\u2019 Aubigne and Postel Score (poor to worse, 18%; 95% CI, 3\u201338%); ORIF group had the highest AVN rate (11%; 95% CI, 0\u201392%); conservative treatment had the highest arthritis rate (67%; 95% CI: 0\u2013100%) and lowest HO rate (2%; 95% CI, 0\u201328%). Discussion: This meta-analysis demonstrates that different procedures lead to various clinical outcomes: fragment excision may achieve better function, conservative treatment may result in a higher arthritis rate, while ORIFs may have a higher AVN rate. These findings may assist surgeons in tailoring their decision-making to specific patient profiles. Future RCTs with multicenter efforts are needed to validate associations found in this study. Level of Evidence: II, systematic review and meta-analysis.<\/jats:p>","DOI":"10.3390\/life12010071","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T01:14:02Z","timestamp":1641518042000},"page":"71","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Does Surgical Repair Benefit Pipkin Type I Femoral Head Fractures?: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"12","author":[{"given":"Sung Huang Laurent","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Che","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou branch, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsai-Sheng","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric H.","family":"Tischler","sequence":"additional","affiliation":[{"name":"The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"},{"name":"Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY 11203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa","family":"Rahman","sequence":"additional","affiliation":[{"name":"The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Kuan","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou branch, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Hsun","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou branch, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Yi","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"675","DOI":"10.2106\/00004623-195840030-00016","article-title":"Primary Vitallium-Mold Arthroplasty for Posterior Dislocation of the Hip with Fracture of the Femoral Head","volume":"40","author":"Kelly","year":"1958","journal-title":"J. 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Trauma"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/1\/71\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:12:53Z","timestamp":1760364773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/12\/1\/71"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,5]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["life12010071"],"URL":"https:\/\/doi.org\/10.3390\/life12010071","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,5]]}}}