Abstract: Objective To investigate the mid- and long-term clinical results of trochanteric flip osteotomy for treating Pipkin
type I and II femoral head fractures. Methods We retrospectively reviewed twenty-three patients (aged 23-72 years with a
mean of 44.1 years, including 15 male and 8 female patients) with femoral head fractures and posterior hip dislocation. The
fracture was classified according to Pipkin classification based radiographic findings, and 9 patients were found to have type I
and 14 had type II fractures. Trochanteric flip osteotomy was performed in all patients for surgical open reduction and internal
fixation of the fractures. The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein
scoring scale and Merle d’ Aubigne-Postel score. Results One patient with follow-up period less than 12 months was excluded
from analysis. Of the 22 patients (95.7%) followed up for more than 12 months (mean 23.5 months), the average Merle d’
Aubigne Postel score was 13.77 at the final follow-up. According to the Thompson-Epstein criteria, 8 (36.4%) patients had
excellent, 9 (40.9%) had good, 3 (13.6%) had fair, and two (9.1%) had poor outcomes; the total rate of excellent and good
outcomes was 77.3% in these 22 patients. None of the patients developed habitual dislocation of the femoral head after the
operation. Heterotopic ossification occurred in 2 patients. Partial neurapraxia of the sciatic nerve occurred in one patient and
recovered completely within 6 months. Three patients developed post-traumatic arthritis, and one of them had avascular
necrosis of the femoral head one year after surgery and received subsequently total hip arthroplasty. Conclusion The
follow-up data demonstrate that trochanteric flip osteotomy is an effective and reliable option for treating Pipkin type I and
type II femoral head fractures.