The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

Abstract

Background Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors. Materials and methods Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared. Results There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up. Conclusions In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.

Multiple screw fixation versus cementless bipolar hemiarthroplasty for femur neck fracture using a nationwide hip fracture registry

“…Indeed, delirium in elderly patients with FNF should be monitored more carefully. Mortality rate at 1 year was not different after MSF and cementless BHA in each group (p > 0.05) and compatible with the findings of previous studies 38 , 39 .…”

Evaluation of functional outcome of intracapsular fracture neck of femur with Austin Moore prosthesis at a tertiary care hospital in Srikakulam

“…In 2019, Pulkit Jain et al [29] concluded in their study that though unipolar AMP faces criticism for acetabular wear, most patients showed excellent to good results and is a good choice in geriatric patients. In 2020, Cui et al [30] in their meta-analysis of 7 randomized controlled trials and five cohort studies, concluded that in the treatment of elderly femoral neck fractures, the internal fixation group has lesser operative time and less bleeding, and the perioperative advantage is more pronounced. However, the Hemi-replacement group had more advantages in postoperative functional scoring and reoperation.…”

Neck of Femur Fracture in Young Patients With End-Stage Renal Disease and Hyperparathyroidism: A Report of Three Cases and Proposed Treatment Algorithm

“…These patients who undergo replacement arthroplasty will be able to weight-bear immediately postoperatively. In contrast to patients who are on non-weight bearing order post-operatively, patients who mobilize early demonstrate an additional functional benefit [13,14]. Besides that, early weight-bearing after replacement arthroplasty has an additional benefit in increasing bone density [14].…”

“…In contrast to patients who are on non-weight bearing order post-operatively, patients who mobilize early demonstrate an additional functional benefit [13,14]. Besides that, early weight-bearing after replacement arthroplasty has an additional benefit in increasing bone density [14]. In ESRD patients with reduced life expectancy, the quality of life after replacement arthroplasty will be of utmost priority when they unfortunately suffer from NOF fractures [15].…”