Internal Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures: A Systematic Review and Meta-Analysis

Abstract

Objective:To compare internal fixation (IF) versus hemiarthroplasty (HA) for elderly individuals (ie, older than 65 years) with nondisplaced (ie, Garden type I or II) femoral neck fracture (FNF).Data Source:We searched English literature of MEDLINE, PubMed, and Embase from inception to December 4, 2021.Study Selection:Eligibility criteria were randomized controlled trials (RCTs) compared IF versus HA for elderly individuals with nondisplaced FNF. Primary outcomes were Harris hip score (HHS), quality of life per European Quality of Life 5 Dimension (EQ-5D), and mortality. Secondary outcomes were complications, reoperation, intraoperative bleeding, operation duration, and length of hospital stay.Data Extraction:Two authors separately extracted data and assessed the risk of bias of the included studies using Cochrane risk-of-bias tool.Data Synthesis:Three RCTs yielding 400 patients were enrolled, of which 203 (50.7%) underwent IF. Internal fixation was inferior to HA with respect to 6-month HHS [mean difference (MD) = −8.28 (−14.46, −2.10), P = 0.009] and 1-year EQ-5D [MD = −0.07 (−0.14, −0.00), P = 0.04]. The 2 techniques were comparable regarding length of hospital stay (day), HHS at 1 and 2 years, EQ-5D at 2 years, and mortality. IF was inferior to HA in implant-related complication [20.1% vs. 6.0%, relative risk (RR) = 3.18 (1.72, 5.88), P = 0.0002] and reoperation rate [20.1% vs. 6.0%, RR = 3.30 (1.79, 6.08), P = 0.0001]. Hemiarthroplasty had a greater blood loss (mL) [MD = −138.88 (−209.58, −68.18), P = 0.001] and operation duration (min) [MD = −23.27 (−44.95, −1.60), P = 0.04] compared with IF.Conclusion:HA is the preferred technique for nondisplaced FNF if early recovery, higher mobility, and better quality of life are priorities. The choice of fixation should be weighed on an individual patient level.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Management of Garden-I and II Femoral Neck Fractures: Perspectives on Primary Arthroplasty

“…Internal fixation performed in 22/110 (20%) patients was found to be a risk factor for major reoperation in comparison to hemiarthroplasty in which reoperation was performed in 5/108 (5%) patients (relative risk reduction [RRR] = 3.3 [95% CI = 0.7 to 10.0]; P = 0.002). 42 This is consistent with the observation that internal fixation is a significant indicator for increased surgical complications, such as nonunion and osteonecrosis, which occurred significantly more often in patients allocated to internal fixation (RRR = 1.8 [95% CI = 0.4 to 4.8]; P = 0.004). As in other studies, and importantly, there were no significant differences in mortality between the two groups.…”

“…Further, there was no statistical significance between the two modalities in terms of function measured by the HHS [MD = −2.73 (−6.26, 0.79), P = 0.13] or mortality [23.4% vs 20.6%, RR = 1.13 (0.75, 1.71), P = 0.48], at 12 months. 42 These data collectively indicate that, despite a higher risk of reoperation, internal fixation may serve as an equivalent intervention as compared to arthroplasty in terms of function and mortality. Arthroplasty continues to be tolerated similarly to internal fixation by the elderly population and offers a function profile like that of internal fixation.…”

“…Further, there was no statistical significance between the two modalities in terms of function measured by the HHS [MD = −2.73 (−6.26, 0.79), P = 0.13] or mortality [23.4% vs 20.6%, RR = 1.13 (0.75, 1.71), P = 0.48], at 12 months. 42 …”

75 years’ journey of malaria publications: what and where?

“…The rising trend might indicate a constant researchers’ interest, opportunities, funding and need for malaria research globally whereas a dip may indicate lack of commitment and complacency due to declining malaria cases around the world. This trend is more conspicuous in Figure 7 where it can be reasonably debated that a sharp decrease in malaria cases between 2010 and 2014 might have translated into a decline in funding for malaria research and therefore leading to a decrease in the number of publications between 2015 and 2020 as noted in this analyses as has been reported by multiple authors in different areas (Hussinger & Carvalho, 2022; Sattari et al, 2022; Jacob and Lefgren, 2011). However, a spurt in the number of malaria cases globally from 2015 and more recently after the COVID-19 (World Malaria Report, 2021, World Malaria Report, 2022), a concomitant response from all stakeholders to enhance commitment in malaria research funding and interest should drive up the annual number of malaria publications past the 2012-2015 levels.…”

Safe range of femoral neck system insertion and the risk of perforation

“…Although some studies suggest that the incidence of hip fractures may be stabilized or decreasing [ 16 – 18 ], there is still a significant concern about the increasing number of hip fractures due to the aging of the global population and the increase in life expectancy. The number of hip fractures is expected to reach 6.3 million by 2050 [ 19 ]. Hip fractures occur predominantly in elderly people, with the reported incidence in the United States of 414/100,000 and 957/100,000 in men and women, respectively.…”