A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis

• Published in: Journal of orthopaedic surgery and research Vol. 12; no. 1; p. 28
• Main Authors: Xu, Dan-Feng, Bi, Fang-Gang, Ma, Chi-Yuan, Wen, Zheng-Fa, Cai, Xun-Zi
• Format: Journal Article
• Language: English
• Published: England BioMed Central 10.02.2017
• Subjects: Age Factors; Aged; Aged, 80 and over; Femoral Neck Fractures - complications; Femoral Neck Fractures - surgery; Femoral Neck Fractures - therapy; Femur Head Necrosis - etiology; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fracture Healing; Humans; Orthopedics; Osteoporotic Fractures - complications; Osteoporotic Fractures - surgery; Osteoporotic Fractures - therapy; Avascular necrosis; Undisplaced femoral neck fracture; Secondary displacement; Surgical treatment; Non-union; Conservative treatment
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-017-0528-9

It remains unclear whether conservative treatment should be used to treat the common undisplaced femoral neck fractures that develop in the elderly. Herein, we systematically review the rates of union and avascular necrosis after conservative and surgical treatment of undisplaced femoral neck fractures. We searched the EMBASE, PubMed, OVID, Cochrane Library, Web of Science, and Scopus databases for randomized controlled trials or observational studies that assessed the outcomes of conservative or surgical treatments of undisplaced femoral neck fractures. No language or publication year limitation was imposed. Statistical analyses were performed with the aid of the chi-squared test. We evaluated the quality of each publication and the risk of bias. Twenty-nine studies involving 5071 patients were ultimately included; 1120 patients were treated conservatively and 3951 surgically. The union rates were 68.8% (642/933) and 92.6% (635/686) in the former and latter groups, respectively (p < 0.001). The avascular necrosis rate in the conservatively treated group was 10.3% (39/380), while it was 7.7% (159/2074) in the surgically treated group (p = 0.09). Surgery to treat undisplaced femoral neck fractures was associated with a higher union rate and a tendency toward less avascular necrosis than conservative treatment.