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The purpose of this study was to review our intermediate-term experience with posterior fracture-dislocations of the hip. We evaluated the accuracy of the Pipkin and Brumback classification schemes as predictors of outcome, assessed the importance of certain treatment variables, and determined the complication rates of this injury in a group of 33 patients followed for an average of 49 months. The overall results were 67% good, 18% fair, and 15% poor, with no excellent results. The Pipkin classification scheme was a useful predictor of outcome because patients with less severe Pipkin 1 or 2 injuries had statistically significant better outcomes than did those who sustained Pipkin 3 or 4 injuries (p < 0.02). Due to a large number of subgroups, we could not demonstrate the usefulness of the Brumback classification system as a predictor of outcome. There were no statistically significant differences in outcome or complication rates when comparing time with hip reduction, definitive operative intervention, or anatomic operative approach to injury. Our study represents the second largest report on posterior dislocation of the hip associated with femoral head fracture. Although outcome of the patients in our series is not outstanding, the 67% good results represent a significant improvement over all previous reports with large numbers of patients. We demonstrate significant improvement in prognosis when treatment goals for these injuries include anatomic reduction, restoration of hip joint stability, and removal of all interposed bone fragments.