Clinical outcomes and Quality-Adjusted Life Years (QALY) after femoral head fractures: A retrospective cohort study of 101 patients.

BACKGROUND: Even though the radiological and functional outcomes following femoral head fractures have been reported earlier, Quality Adjusted Life Years (QALY) after fixation of these fractures has not yet been studied. This study aims at a subgroup analysis of the Pipkins classification of fractures, radiological and functional outcomes, and the burden of femoral head fractures by QALY.

METHODS: A retrospective analysis of 101 patients with femoral head fractures was performed between 2008 and 2022 with a minimum follow-up of 2 years and maximum of 15 years. Serial radiographs were studied from PACS (radiological outcome) and the patients were interviewed using Harris Hip Score (functional outcome) and the EuroQoL EQ-5D-3L questionnaires to assess the Quality Adjusted Life Years (QALY).

RESULTS: Patients who underwent immediate reduction of the hip joint (<6 h) demonstrated better QALY in the long term follow up. Those with Pipkins type 3 (n = 10) fractures who had to undergo Primary THR showed the best functional outcomes, followed by types 4,1, and 2. Infra foveal fractures gave a better outcome than supra foveal fractures. Heterotopic ossification (7%), AVN (4%), and the need for conversion to secondary THR (3%) was more common in patients who had a prolonged injury to reduction interval or a comminuted fracture of the femoral head. Despite a 2% incidence of infection, short-term functional outcomes remained positive in these patients.

CONCLUSION: In this cohort, well-fixed femoral head fractures across Pipkin subtypes showed satisfactory radiological and functional outcomes with acceptable long-term health utility. Pipkin type II fractures with extensive comminution and Pipkin type III fractures appeared to have better outcomes with primary total hip replacement, potentially reducing the need for secondary surgery.