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

• Published in: Journal of orthopaedic surgery and research Vol. 15; no. 1; pp. 1 - 11
• Main Authors: Cui, Shuai, Wang, Dehui, Wang, Xuejie, Li, Zehui, Guo, Wenlai
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 21.09.2020; BioMed Central; BMC
• Subjects: Analysis; Bone implants; Care and treatment; Clinical trials; Decubitus ulcer; Elderly; Embolism; Evidence-based medicine; Femoral neck fractures; Femur; Fractures; Fractures (Injuries); Health aspects; Hemiarthroplasty; Hip; Infections; Internal fixation; Meta-analysis; Mortality; Orthopedics; Patients; Pressure ulcers; Pulmonary embolism; Pulmonary embolisms; Quality of life; Sensitivity analysis; Statistical analysis; Surgery; Systematic Review; The elderly; Thrombosis; Trauma; Veins & arteries
• DOI: 10.1186/s13018-020-01958-2
• ISSN: 1749-799X

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. Keywords: Femoral neck fractures, The elderly, Internal fixation, Hemiarthroplasty, Meta-analysis