The Risk of Avascular Necrosis Following the Stabilization of Femoral Neck Fractures: A Systematic Review and Meta-Analysis

Abstract

Background: Avascular necrosis (AVN) of the femoral head often requires surgical treatment and is often associated with femoral neck fractures. We conducted a systematic review and meta-analysis of recent research on the risk of AVN following the stabilization of fractured femoral neck with implants in PubMed. We assessed the effect of age on AVN incidence among patients aged > 50 and younger, depending on fracture type, Garden stage, Pouwels degree, Delbet stage, and age category. We followed PRISMA guidelines. Relevant studies were defined as research articles describing real-world studies reporting on the risk of AVN following primary surgical fracture stabilization with implants, published between 1 January 2011 and 22 April 2021. Fifty-two papers met the inclusion criteria, with a total of N = 5930 with surgically managed fractures. The pooled mean AVN incidence was significantly higher among patients with displaced fractures (20.7%; 95% CI: 12.8–28.5%) vs. those with undisplaced fractures (4.7%; 95% CI: 3.4–6.0%). No significant correlation was observed between AVN incidence weighted by sample size and time interval from injury to surgery (p = 0.843, R2 = 0.01). In conclusion, the risk of AVN following femoral neck fractures was generally high, especially in patients with displaced fractures. The time from injury to surgery did not correlate with AVN incidence.

Mechanical analysis of the femoral neck dynamic intersection system with different nail angles and clinical applications

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“…While osteonecrosis most frequently affects the femur, it can occur in various bones throughout the body. Osteonecrosis can be linked to a range of factors including the use of certain medications, traumatic injuries, excessive alcohol and narcotic consumption, or exposure to radiation [1][2][3]. Osteonecrosis of the jaw (ONJ), a specific form of osteonecrosis, greatly impacts the patient's quality of life and contributes to a notable mortality rate.…”

Gamma Nail Combined with One Cannulated Compression Screw Fixation for Treating Pauwels Type III Femoral Neck Fractures in Young and Middle‐Aged Adults: Clinical Follow‐Up and Biomechanical Studies

“…[1][2][3] In young adults, most femoral neck fractures are vertically unstable shear fractures (Pauwels type III femoral neck fracture), with a high incidence of postoperative femoral head ischemia and necrosis. 4 Anatomic reduction and stable internal fixation are among the principles for treating these fractures. 5 Stable fixation of fractures requires a reliable internal fixation device.…”

“…The incidence of femoral neck fracture, as an intracapsular fracture, has been increasing annually, particularly in young people 1–3 . In young adults, most femoral neck fractures are vertically unstable shear fractures (Pauwels type III femoral neck fracture), with a high incidence of postoperative femoral head ischemia and necrosis 4 . Anatomic reduction and stable internal fixation are among the principles for treating these fractures 5 …”