Comparison of femoral neck system versus cannulated screws for treatment of femoral neck fractures: a systematic review and meta-analysis

Abstract

Background Recently, some studies on the efficacy of the femoral neck system (FNS) in treating femoral neck fractures (FNFs) have been published. Therefore, a systematic review was performed to clarify the efficacy and safety of FNS versus cannulated screws (CS) for the treatment of FNFs. Method The PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing FNS and CS fixations in FNFs. Intraoperative indicators, postoperative clinical indicators, postoperative complications, and postoperative scores were compared between the implants. Results A total of eight studies were included in the study, involving 448 FNFs patients. The results showed that patients in FNS group were significantly lower than the CS group in the number of X-ray exposures (WMD = -10.16; 95% CI, -11.44 to -8.88; P < 0.001; I2 = 0%), fracture healing time (WMD = -1.54; 95% CI, -2.38 to -0.70; P < 0.001; I2 = 92%), length of femoral neck shortening (WMD = -2.01; 95% CI, -3.11 to -0.91; P < 0.001; I2 = 0%), femoral head necrosis (OR = 0.27; 95% CI, 0.08 to 0.83; P = 0.02; I2 = 0%), implant failure/cutout (OR = 0.28; 95% CI, 0.10 to 0.82; P = 0.02; I2 = 0%), and Visual Analog Scale Score (WMD = -1.27; 95% CI, -2.51 to -0.04; P = 0.04; I2 = 91%). And the Harris Score was significantly higher in the FNS group than in the CS group (WMD = 4.15; 95% CI, 1.00 to 7.30; P = 0.01; I2 = 89%). Conclusions Based on this meta-analysis, FNS shows better clinical efficacy and safety in treating FNFs compared to CS. However, due to the limited quality and number of included studies and the high heterogeneity of the meta-analysis; large samples and multicenter RCTs are needed to confirm this conclusion in the future. Level of evidence II, Systematic review and Meta-analysis. Trial registration PROSPERO CRD42021283646.

Pre-sliding of the femoral neck system to prevent postoperative shortening of femoral neck fractures

“…The analysis showed that the occurrence of shortening was concentrated at 3 months postoperatively and basically reached a stable state within 6 months, with less persistent shortening occurring after 6 months. The mean shortening distance at 1 year postoperatively was (6.5 ± 6.4) mm, which was similar to previous reports of mean shortening in the range of 4.9 mm–8.4 mm, and seemed to be consistent with no progression of results at 3 months [ 17 , 21 , 22 ]. The reason may be due to the shortening caused by resorption and plastic modification of the fracture during fracture healing, and secondly, the excessive shortening of the affected limb combined with cortical comminution of the fracture and bone defect due to irrational weight bearing.…”

Simple Minimally Invasive Method to Reduce Valgus‐Impacted and Tilted Femoral Neck Fractures without Soft Tissue or Cartilage Injury: Radiological and Clinical Results

“…In summary of the studies so far, FNS seems to be able to significantly reduce femoral neck shortening in particular. In addition, with regard to prognosis, implant‐related complications and osteonecrosis are reduced, and postoperative pain visual analog scales (VAS) and HHS score are also thought to be improved 41 …”

“…In addition, with regard to prognosis, implant‐related complications and osteonecrosis are reduced, and postoperative pain visual analog scales (VAS) and HHS score are also thought to be improved. 41 …”

What’s New in Orthopaedic Trauma

“…The importance of an anatomic reduction for a femoral neck fracture is clear, but the optimal implant for fixation remains unclear. A systematic review and meta-analysis compared the femoral neck system with cannulated screws 12 . Eight studies with 448 patients were included.…”