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. 2025 Aug 18;12:1554603. doi: 10.3389/fsurg.2025.1554603

Figure 3.

Flowchart showing decision making for hip treatment. Top shows hip joint with fracture. Left path: No advanced arthritis or immobilization, young patients leading to Open Reduction and Internal Fixation (ORIF) visualization. Right path: Illustration of Comminuted femoral head fractures or advanced arthritis in elderly patients leading to Total Hip Arthroplasty.

Illustrative diagram of recommended treatment variables for Pipkin type III fractures. Attempts for hip preservation in young patients with ORIF in the femoral head can be stabilized superiorly or inferiorly in fractured fragments with a countersunk or headless compression screw subchondral. The Smith-Peterson approach, which reduces surgical duration and blood loss, facilitates this stabilization. The stabilization of the femoral neck can be performed using percutaneous reduction with cannulated screws. Total hip replacement is selected for comminuted femoral head fractures with advanced arthritis or restricted joints in the elderly patients.