Anterior approach versus posterior approach for Pipkin I and II femoral head fractures: A systemic review and meta-analysis

• The optimal surgical approach for Pipkin I and II fractures remains controversial.
• Due to poor evidence judging anterior approach or posterior approach for femoral head fractures, we perform a meta-analysis.
• The posterior approach would decrease the risk of heterotopic ossification compared with the anterior approach.

PurposeWe performed a meta-analysis, pooling the results from controlled clinical trials to compare the efficiency of anterior and posterior surgical approaches to Pipkin I and II fractures of the femoral head.MethodsPotential academic articles were identified from the Cochrane Library, Medline (1966–2015.5), PubMed (1966–2015.5), Embase (1980–2015.5) and ScienceDirect (1966–2015.5) databases. Gray studies were identified from the references of the included literature. Pooling of the data was performed and analyzed by RevMan software, version 5.1.ResultsFive case-control trials (CCTs) met the inclusion criteria. There were significant differences in the incidence of heterotopic ossification (HO) between the approaches, but no significant differences were found between the two groups regarding functional outcomes of the hip, general postoperative complications, osteonecrosis of the femoral head or post-traumatic arthritis.ConclusionThe present meta-analysis indicated that the posterior approach decreased the risk of heterotopic ossification compared with the anterior approach for the treatment of Pipkin I and II femoral head fractures. No other complications were related to anterior and posterior approaches. Future high-quality randomized, controlled trials (RCTs) are needed to determine the optimal surgical approach and to predict other postoperative complications.Level of evidenceIII.