Long‐Term Efficacy of Screw Fixation <i>vs</i> Hemiarthroplasty for Undisplaced Femoral Neck Fracture in Patients over 65 Years of Age: A Systematic Review and Meta‐Analysis

Xu, Wennan; Xue, Qingyun

doi:10.1111/os.12910

Cited by 9 publications

(17 citation statements)

References 28 publications

(72 reference statements)

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“…7 In elderly patients, arthroplasty is typically recommended for displaced FNFs, 8,9 whereas treatment of nondisplaced FNFs is debatable. [9][10][11][12][13] Numerous studies have compared primary outcomes between nondisplaced FNFs treated with internal fixation (IF) versus hemiarthroplasty (HA) with varying results. [14][15][16][17][18][19][20] Two cross-sectional studies found similar revision rates between the 2 techniques 15,20 ; while IF was associated with higher reoperations in other studies.…”

Section: Introductionmentioning

confidence: 99%

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

Sattari

Guilbault

MacMahon

et al. 2023

Journal of Orthopaedic Trauma

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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.

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Section: Introductionmentioning

confidence: 99%

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

Sattari

Guilbault

MacMahon

et al. 2023

Journal of Orthopaedic Trauma

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“…The literature suggests use of THA or HA for femoral neck fractures in non-displaced fractures due to early mobilization and less postoperative complications. [10][11][12][13][14][15]20,21 In a recent study, Lu et al 22 found less postoperative complications and lower reoperation rate as well as better functional recovery in patients treated with HA compared to IF in non-or minimal displaced femoral neck fractures. Although this study includes old patients with comorbidities, patients with a highly impaired general condition and poor mobility were excluded.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 11 Several studies reported a better clinical outcome for elderly patients especially with displaced femoral neck fractures treated with hemiarthroplasty compared to CRIF. 12 - 15 A recent study however showed poor clinical outcome of elderly patients with hip fractures and comorbidities treated with hemiarthroplasty. 2 Since June 2018, we use the Femoral Neck System (FNS, DePuy-Synthes, Zuchwil, Switzerland) for minimal invasive hip fractures classified Garden I.…”

Section: Introductionmentioning

confidence: 99%

Early Results in Non-Displaced Femoral Neck Fractures Using the Femoral Neck System

Cintean

Pankratz

Hofmann

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction Femoral neck fractures in the elderly are a major event and are rising in incidence over the last decade. Advancing age and numerous comorbidities largely account for high mortality rate and require geriatric expertise. Treatment options are total hip arthroplasty (THA), hemiarthroplasty (HA) or osteosynthesis. Literature suggests THA or HA for better outcomes, although no clear guidelines exist. Material and methods A retrospective chart review was performed of 63 patients (80 ± 11 years; 32 women, 31 men) with Garden one femoral neck fractures treated between June 2018 and June 2020 with either HA or internal fixation with the Femoral Neck System (FNS). Primary outcome measures were surgical and non-surgical complication rates and best achievable mobilization during the hospital stay. Results Thirty four patients were treated with HA, and 29 with the FNS. Mobilization was measured using the Charité Mobility Index (CHARMI). No difference between age, ASA, CCI or preoperative CHARMI was found. The CHARMI was significantly lower in the HA group. No difference in surgical complications was found. The HA cohort showed more non-surgical complications, a longer ICU stay and more blood transfusions. Hospitalization was significant longer in the HA than the FNS cohort (15.1 ± 5.1 vs 9.8 ± 3.8 days). Radiographic controls were performed after 6 and 12 weeks. The FNS group showed a mean shortening of 3.3 mm. 4 of 21 patient had shortening >5 mm. 20 of 21 patients showed radiographic signs of bone healing after 3 months. Conclusion Early results with the FNS show faster recovery than patient with hemiarthroplasty. Internal fixation with the FNS may be an option in non-displaced femoral neck fractures. Further studies should be performed to better evaluate the FNS compared to traditional internal fixation methods and arthroplasty.

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“…Though arthroplasty had several advantages, such as improved mobility and fewer major reoperations, it was reported that there was no significant difference between internal fixation and arthroplasty in long-term mortality and reestablishing hip functions. 9,10 . Besides, the result of a successful hip replacement is not exactly equivalent to a united femoral neck fracture, especially in Chinese elderly patients who like squatting or sitting cross-legged.…”

Section: Introductionmentioning

confidence: 99%

“…However, the optimal management of nondisplaced elderly femoral neck fractures remains controversial. Though arthroplasty had several advantages, such as improved mobility and fewer major reoperations, it was reported that there was no significant difference between internal fixation and arthroplasty in long‐term mortality and reestablishing hip functions 9,10 …”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients

Zhu

Deng

et al. 2022

Orthopaedic Surgery

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Objective To investigate whether four‐screw fixation in rhombic configuration could improve the clinical outcomes and decrease the complication rate compared with three‐screw fixation in inverted triangle configuration in elderly patients with nondisplaced femoral neck fractures. Method From January 2018 to January 2019, 91 elderly patients with nondisplaced femoral neck fractures who were treated with a cannulated screw system were reviewed retrospectively. The inverted triangle configuration was applied in 51 patients and rhombic configuration in 40 patients. The demographic and perioperative information of the patients were extracted from medical records and surgical records. Variables including incision size, surgical blood loss, surgical time, fluoroscopy time, hospital stays, fracture union time, postoperative visual analogue scale (VAS) scores, and complications were compared between the two groups. Also, Harris hip score at the final follow‐up was used to evaluate the functional outcomes. Results All patients were followed up from 24 to 36 months, with an average of 29.75 months. The average age of patients was 72.37 ± 7.16 years. No significant differences were found between the two groups with regard to patients' age, gender, affected side, Garden classification, Pauwels classification and comminution of posterior wall (P > 0.05). We found shorter incision size (P < 0.001), less blood loss (P = 0.020), less surgical time (P = 0.026), and shorter fluoroscopy time (P < 0.001) in inverted triangle configuration group. However, shorter hospital stays (P = 0.001) and fracture union time (P = 0.002) were found in the rhombic configuration group. The VAS scores were lower in the rhombic configuration group at the first (P < 0.001) and third months (P = 0.010), but no significant difference was found at the sixth month (P = 0.075). Meanwhile, the total complication rate was relatively lower in the rhombic configuration group compared to the inverted triangle configuration group (P = 0.041). Harris hip score presented no significant difference between the two groups at final follow‐up (P = 0.078). No wound infection or cortical perforation occurred in either group. Conclusion Four‐screw fixation in rhombic configuration was superior to three‐screw fixation in inverted triangle configuration in the treatment of nondisplaced femoral neck fractures in elderly patients in terms of less early postsurgical pain, shorter fracture union time, and lower complication rate.

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Long‐Term Efficacy of Screw Fixation vs Hemiarthroplasty for Undisplaced Femoral Neck Fracture in Patients over 65 Years of Age: A Systematic Review and Meta‐Analysis

Cited by 9 publications

References 28 publications

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

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

Early Results in Non-Displaced Femoral Neck Fractures Using the Femoral Neck System

Comparison of the Effect of Rhombic and Inverted Triangle Configurations of Cannulated Screws on Internal Fixation of Nondisplaced Femoral Neck Fractures in Elderly Patients

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