Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review

Oñativia, José Ignacio; Slullitel, Pablo; Dilernia, Fernando Díaz; Viezcas, Juan M Gonzales; Vietto, Valeria; Ramkumar, Prem N.; Buttaro, Martín; Piuzzi, Nicolás S.

doi:10.5301/hipint.5000532

Cited by 51 publications

(65 citation statements)

References 59 publications

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“…Procedure -specific complication. A slightly higher complication rate in the present study (41%) is found, when comparing the results with the literature (32.3-38.8%) [3][4][5][6][7] . Table 6 shows a detailed description of this comparison.…”

Section: Discussionsupporting

confidence: 74%

“…Furthermore, in the meta-analysis of Pitzl and the study of Chen, there were examined displaced and undisplaced femoral neck fractures treated by head-preserving operative methods (dynamic hip screw and cannulated screws) 5,7 . In the meta-analysis of Oñativia, there were examined undisplaced femoral neck fractures treated by cannulated screw fixation 6 . In the study of Wang, there were examined displaced femoral neck fractures treated by head-preserving operative methods (dynamic hip screw or cannulated screws) 3 .…”

Section: Discussionmentioning

confidence: 99%

“…However, the benefit of maintaining the femoral head can be associated with numerous complications: femoral head necrosis, nonunion, femoral neck shortening, screw loosening, implant penetration 2 . Numerous studies on the outcome of head-preserving femoral neck fractures have a relatively high rate of osteosynthesis failure, in some cases >40% [3][4][5][6][7] . Some studies about non-displaced femoral neck fractures with head-preserving operation have shown that higher age is associated with an increase in revisions, complications, nonunion and poor functional outcome [8][9][10] .…”

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confidence: 99%

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Factors that influence the complications and outcomes of femoral neck fractures treated by cannulated screw fixation

Ramadanov

Toma

Herkner

et al. 2020

Sci Rep

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To investigate the influence of various factors on the two outcome parameters "procedure-specific complication" (femoral head necrosis, infection, nonunion, femoral neck shortening, screw loosening, implant penetration) and "functional outcome" in patients with displaced and undisplaced femoral neck fracture treated by cannulated screw fixation. All cases of a femoral neck fracture, operated by cannulated screw fixation, in the period from December 2014 to December 2017 were included. The observation period of the included patients was 12 months. Information on their outcome was collected after evaluation of current x-ray images and on request from the responsible further treatment physician. Continuous data were presented as mean value ± standard deviation, categorical data as absolute and relative frequency. The effect of potential factors on endpoints was estimated with a multivariable logistic regression analysis and 95% confidence intervals calculated. The null hypothesis odds Ratio = 1 was checked by the Wald test. The likelihood ratio test was used to test for deviation from linearity. The mean age of the 56 included patients was 72 years (36 min, 96 max), 44.5% (n = 25) were male and 55.5% (n = 25) female. The femoral neck fractures were classified as follows:

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Factors that influence the complications and outcomes of femoral neck fractures treated by cannulated screw fixation

Ramadanov

Toma

Herkner

et al. 2020

Sci Rep

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“…Approximately half of the hip fractures are femoral neck fractures. Numerous studies on the outcome of femoral neck fractures, operated by a headpreserving method, showed a high risk for osteosynthesis failure, in some cases > 40% [3][4][5][6][7][8]. In elderly patients with femoral neck fractures, artificial hip replacement should be considered [8].…”

Section: Introductionmentioning

confidence: 99%

Comparison of short-term outcomes between SuperPATH approach and conventional approaches in hip replacement: a systematic review and meta-analysis of randomized controlled trials

et al. 2020

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Background It remains uncertain if the new SuperPATH approach benefits patients in artificial hip joint replacement. We conducted a systematic review and meta-analysis of randomized controlled trials to compare the short-term outcome of SuperPATH approach and conventional approaches in hip joint replacement. Methods A systematic literature search up to April 2020 was performed to identify randomized controlled trials comparing SuperPATH with conventional approaches in hip joint replacement. We measured surgical, functional, and radiological outcomes. Mean differences or odds ratios with 95% confidence intervals were calculated and pooled using random effects models and the Hartung-Knapp-Sidik-Jonkman method. Results A total of 12 RCTs involving 726 patients met the inclusion criteria, one trial with a level I evidence, 11 trials with level II evidence. The overall meta-analysis showed that SuperPATH approach reduced incision length (MD = − 4.84, 95% CI − 7.04 to − 2.64, p < 0.01), pain VAS 7 day postoperatively (MD = − 1.39, 95% CI − 2.57 to − 0.21, p = 0.03), and HHS 7 day postoperatively (MD = 10.24, 95% CI 0.27 to 20.21, p = 0.05). The two approaches did not differ in acetabular cup positioning angles, intra- and postoperative blood loss, hospitalization period, and postoperative complications. Hip replacement via SuperPATH approach had a longer operation time than hip replacement via conventional approaches. Conclusions SuperPATH approach showed better results in decreasing incision length and early pain intensity as well as improvement of short-term functional outcome. Long-term outcomes of SuperPATH approach need to be investigated.

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“…Doubts have been raised regarding the results of the internal fixation of minimally displaced FNF [2]. In elderly patients, reoperation rates ranging from 8 to 19% have been reported [2][3][4][5]. The alternative treatment using hip arthroplasty is controversial.…”

Section: Introductionmentioning

confidence: 99%

A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: a pilot study for a clinical trial

Mukka

Sjöholm

Aziz

et al. 2020

Pilot Feasibility Stud

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Introduction: The literature regarding undisplaced femoral neck fractures (FNF) is sparse. The aim of this prospective feasibility study is to compare the clinical outcome after undisplaced FNF treated with internal fixation (IF) and displaced FNF treated with hip arthroplasty. We hypothesized that hip arthroplasty would give a lower incidence of reoperations. Methods: A total of 235 patients were included with a median age of 84 years (range 65-99). A consecutive series of 65 patients with undisplaced FNF were treated with IF, and 170 patients with displaced FNF were treated with either a total hip arthroplasty or a hemiarthroplasty. Follow-up interviews were conducted at 1 year using the Harris Hip Score (HHS), WOMAC, and pain numeric rating scale (PNRS). The minimum follow-up time was 22 months. There was no difference in baseline data between the groups. Results: Nineteen (8%) hips required reoperation at least once at a mean of 6 months (range 0-35). The rate of reoperation was higher in the IF group compared to the hip arthroplasty group (13.8% vs. 5.9%, 95% CI 0.9-6.4). The overall 1-year and 2-year mortality was 28% and 40%, respectively, with no difference between the groups. The most common reasons for reoperations in the IF group were non-union and avascular necrosis, and 6 patients were treated with hip or excision arthroplasty. In the arthroplasty group, the most common indications were deep infection and dislocation. We did not find any differences between the groups in terms of HHS, WOMAC, and PNRS. Conclusions: In this feasibility study, we found no differences in patient-reported outcomes between the groups although IF required a higher rate of reoperations. Further randomized trials are needed to establish the optimal treatment of undisplaced FNF in the elderly.

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Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review

Abstract: Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates. Further prospective high-quality, randomised controlled trials are required to establish the optimal approach for the treatment of UFNF.

Cited by 51 publications

References 59 publications

Factors that influence the complications and outcomes of femoral neck fractures treated by cannulated screw fixation

Factors that influence the complications and outcomes of femoral neck fractures treated by cannulated screw fixation

Comparison of short-term outcomes between SuperPATH approach and conventional approaches in hip replacement: a systematic review and meta-analysis of randomized controlled trials

A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: a pilot study for a clinical trial

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